Provider Demographics
NPI:1033479076
Name:MILLER, SHERRY ANN (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 JUANITA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-2259
Mailing Address - Country:US
Mailing Address - Phone:325-277-3123
Mailing Address - Fax:
Practice Address - Street 1:2601 W AVENUE N
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76909-2601
Practice Address - Country:US
Practice Address - Phone:325-942-2173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT 13782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer