Provider Demographics
NPI:1083758072
Name:SHIVERS, SHERRA K (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:SHERRA
Middle Name:K
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:SUITE 460
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-1447
Mailing Address - Country:US
Mailing Address - Phone:334-794-0591
Mailing Address - Fax:334-793-6073
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:SUITE 460
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1447
Practice Address - Country:US
Practice Address - Phone:334-794-0591
Practice Address - Fax:334-793-6073
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7589225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51512482SHIOtherBCBS