Provider Demographics
NPI:1124205265
Name:WISEMAN, SHERRY LEE (PT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:WISEMAN
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 1:510 W MAIN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-1454
Mailing Address - Country:US
Mailing Address - Phone:330-702-0110
Mailing Address - Fax:330-702-0510
Practice Address - Street 1:510 W MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-1454
Practice Address - Country:US
Practice Address - Phone:330-702-0110
Practice Address - Fax:330-702-0510
Is Sole Proprietor?:No
Enumeration Date:2008-01-30
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH007236225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH366676Medicare Oscar/Certification