Provider Demographics
NPI:1962619676
Name:GELETKA, SHERYL LANG (LMT)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:LANG
Last Name:GELETKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 BRADEN AVE
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-2053
Mailing Address - Country:US
Mailing Address - Phone:941-359-9090
Mailing Address - Fax:941-360-1595
Practice Address - Street 1:373 BRADEN AVE
Practice Address - Street 2:SUITE #101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-2053
Practice Address - Country:US
Practice Address - Phone:941-359-9090
Practice Address - Fax:941-360-1595
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA42025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA42025OtherLIC. MASSAGE THERAPIST