Provider Demographics
NPI:1093881831
Name:MCCORMACK, MERYL SHERMAN (PT)
Entity Type:Individual
Prefix:MS
First Name:MERYL
Middle Name:SHERMAN
Last Name:MCCORMACK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 ROBYN DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5049
Mailing Address - Country:US
Mailing Address - Phone:925-838-2455
Mailing Address - Fax:925-838-2455
Practice Address - Street 1:1240 ROBYN DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5049
Practice Address - Country:US
Practice Address - Phone:925-838-2455
Practice Address - Fax:925-838-2455
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA151032251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics