Provider Demographics
NPI:1063822518
Name:BRANDON, SHERRY (LMT, BS)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:BRANDON
Suffix:
Gender:F
Credentials:LMT, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BART GREEN DR
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-4608
Mailing Address - Country:US
Mailing Address - Phone:423-773-4960
Mailing Address - Fax:
Practice Address - Street 1:160 BART GREEN DR
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-4608
Practice Address - Country:US
Practice Address - Phone:423-773-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-06
Last Update Date:2014-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6208225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist