Provider Demographics
NPI:1770049496
Name:SHERRILL BELCZYK, DIANE L (LMT)
Entity type:Individual
Prefix:MS
First Name:DIANE
Middle Name:L
Last Name:SHERRILL BELCZYK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MS
Other - First Name:DIANE
Other - Middle Name:L
Other - Last Name:SHERRILL BELCZYK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMT
Mailing Address - Street 1:8001 BRIARWOOD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99518-3335
Mailing Address - Country:US
Mailing Address - Phone:907-360-0106
Mailing Address - Fax:
Practice Address - Street 1:1655 OKPIK ST
Practice Address - Street 2:
Practice Address - City:UTQIAGVIK
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-360-0106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-18
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1112874225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist