Provider Demographics
NPI:1013068303
Name:LITWILLER, SHERRY L (P T)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:LITWILLER
Suffix:
Gender:F
Credentials:P T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2351 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IL
Mailing Address - Zip Code:61554-3972
Mailing Address - Country:US
Mailing Address - Phone:309-353-5940
Mailing Address - Fax:309-353-1654
Practice Address - Street 1:2351 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEKIN
Practice Address - State:IL
Practice Address - Zip Code:61554-3972
Practice Address - Country:US
Practice Address - Phone:309-353-5940
Practice Address - Fax:309-353-1654
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070003686225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0029040313OtherIL BLUE CROSS BLUE SHIELD
IL0038240397OtherBLUE CROSS BLUE SHIELD
IL0028240478OtherIL BLUE CROSS BLUE SHIELD
IL0038240397OtherBLUE CROSS BLUE SHIELD