Provider Demographics
NPI:1093968281
Name:SHERMAN, SUSAN MARY (LMP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:MARY
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 OLD GARDINER RD
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-8701
Mailing Address - Country:US
Mailing Address - Phone:360-797-7830
Mailing Address - Fax:
Practice Address - Street 1:1215 1ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-4323
Practice Address - Country:US
Practice Address - Phone:360-301-1645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-31
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 00010494225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist