Provider Demographics
NPI:1164638532
Name:EVESLAGE, SHERRY ANN (PT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:EVESLAGE
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 1:130 WASHBURNE DR
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-1824
Mailing Address - Country:US
Mailing Address - Phone:320-845-6108
Mailing Address - Fax:320-845-6127
Practice Address - Street 1:300 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:MN
Practice Address - Zip Code:56307-9363
Practice Address - Country:US
Practice Address - Phone:320-845-6108
Practice Address - Fax:320-845-6127
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist