Provider Demographics
NPI:1124182571
Name:SHERRY NANCE
Entity Type:Organization
Organization Name:SHERRY NANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-685-7227
Mailing Address - Street 1:4646 E GREENWAY RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4805
Mailing Address - Country:US
Mailing Address - Phone:602-923-6750
Mailing Address - Fax:602-923-6804
Practice Address - Street 1:4646 E GREENWAY RD
Practice Address - Street 2:SUITE 110
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4805
Practice Address - Country:US
Practice Address - Phone:602-923-6750
Practice Address - Fax:602-923-6804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7169A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ036551Medicare ID - Type Unspecified