Provider Demographics
NPI:1033300322
Name:SHERK, JESSICA MILLER (PTA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:MILLER
Last Name:SHERK
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:MYERSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:17067-1000
Mailing Address - Country:US
Mailing Address - Phone:717-866-8881
Mailing Address - Fax:
Practice Address - Street 1:1 BOYD ST
Practice Address - Street 2:
Practice Address - City:CORNWALL
Practice Address - State:PA
Practice Address - Zip Code:17016
Practice Address - Country:US
Practice Address - Phone:717-507-5311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE001849L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant