MEDICARE: SHERYL P TRASK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1083887343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHERYL P TRASK

Provider Business Mailing Address
First Line	:	5480 LAKE RD S
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9754
Country	:	US
Telephone Number	:	585-637-8305
Fax Number	:

Provider Business Practice Location Address
First Line	:	5480 LAKE RD S
Second Line	:
City	:	BROCKPORT
State	:	NY
Zip	:	14420-9754
Country	:	US
Telephone Number	:	585-637-8305
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHERYL TRASK
Credential	:	PT
Telephone Number	:	585-637-8305

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	06/13/2008

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