Provider Demographics
NPI:1568205409
Name:DVORAK, SHERI (LMT, BCTMB)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:DVORAK
Suffix:
Gender:F
Credentials:LMT, BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300-306 W WASHINGTON ST.
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OREGON
Mailing Address - State:IL
Mailing Address - Zip Code:61061
Mailing Address - Country:US
Mailing Address - Phone:303-815-0518
Mailing Address - Fax:
Practice Address - Street 1:300-306 W WASHINGTON ST.
Practice Address - Street 2:SUITE 208
Practice Address - City:OREGON
Practice Address - State:IL
Practice Address - Zip Code:61061
Practice Address - Country:US
Practice Address - Phone:303-815-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.019317225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist