Provider Demographics
NPI:1184859159
Name:SHELTON, SHERI ANN (PT)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:ANN
Last Name:SHELTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SHERI
Other - Middle Name:ANN
Other - Last Name:WOROSCHUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 SW INDUSTRIAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1093
Mailing Address - Country:US
Mailing Address - Phone:541-585-2529
Mailing Address - Fax:541-585-2535
Practice Address - Street 1:155 SW CENTURY DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1657
Practice Address - Country:US
Practice Address - Phone:541-322-9045
Practice Address - Fax:541-322-9044
Is Sole Proprietor?:No
Enumeration Date:2009-05-20
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR059333037OtherREGENCE BLUE CROSS