Provider Demographics
NPI:1154656312
Name:WORMSER, SHERRI LYNNE (RPT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNNE
Last Name:WORMSER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 W EMERALD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9015
Mailing Address - Country:US
Mailing Address - Phone:208-375-0666
Mailing Address - Fax:208-685-2767
Practice Address - Street 1:1401 MAIN AVE UNIT A
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5194
Practice Address - Country:US
Practice Address - Phone:970-259-5776
Practice Address - Fax:970-259-9975
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-8363225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist