Individual provider Active NPI

Sheryl Villasis, PT/DPT

  • Specialist
  • Colorado Springs, CO
National Provider Identifier
1053774471
Registry record updated Apr 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
9886 Issued in CO
Practice address
5820 Flintridge Dr
Colorado Springs, CO 80918-1883
Phone
(719) 599-7328
Fax
(719) 264-0227
NPI assigned
Apr 2, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 2, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 9886 CO Primary

Addresses

Primary practice location

5820 Flintridge Dr
Colorado Springs, CO 80918-1883

Mailing address

5820 Flintridge Dr
Colorado Springs, CO 80918-1883
Phone (719) 599-7328

Other identifiers 1

IdentifierTypeStateIssuer
2251500000XMedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231012002941 VA Practitioner - Physical Therapist in Private Practice 5698120590 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
9886COMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Legacy Healthcare Services Inc CurrentSince Dec 4, 2023 Accepting new patients

Locations

110 Horizon Dr
#310
Raleigh, NC 27615

110 Horizon Dr
Ste 310
Raleigh, NC 27615
Phone (970) 215-3300

3365 Ogden Rd
Roanoke, VA 24018
Phone (540) 682-7500

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1459555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459555200000",
    "number": "1053774471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5820 FLINTRIDGE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809181883",
            "telephone_number": "719-599-7328",
            "fax_number": "719-264-0227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5820 FLINTRIDGE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809181883",
            "telephone_number": "719-599-7328",
            "fax_number": "719-264-0227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VILLASIS",
        "first_name": "SHERYL",
        "credential": "PT/DPT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-02",
        "last_updated": "2016-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CO",
            "license": "9886",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2251500000X",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.