Provider Demographics
NPI:1114430956
Name:DYER, SHERRI LYNN (PTA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:DYER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:LYNN
Other - Last Name:HEIMKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:7390 PAWLAK LN
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:WI
Mailing Address - Zip Code:54139-9716
Mailing Address - Country:US
Mailing Address - Phone:920-373-4804
Mailing Address - Fax:
Practice Address - Street 1:729 PARK ST
Practice Address - Street 2:
Practice Address - City:ANTIGO
Practice Address - State:WI
Practice Address - Zip Code:54409-2745
Practice Address - Country:US
Practice Address - Phone:715-623-2356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-15
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant