Healthcare Provider Details

I. General information

NPI: 1518929371
Provider Name (Legal Business Name): SHERYL LEE POREMBA PT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14821 FOUNDERS XING
HOMER GLEN IL
60491-6705
US

IV. Provider business mailing address

14732 S GOLDEN OAK DR
HOMER GLEN IL
60491-8003
US

V. Phone/Fax

Practice location:
  • Phone: 708-301-9933
  • Fax: 708-301-4450
Mailing address:
  • Phone: 708-301-1541
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: