Provider Demographics
NPI:1275048407
Name:FOLLIS, SHERI ANNETTE (PTA)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:ANNETTE
Last Name:FOLLIS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAKE ALFRED
Mailing Address - State:FL
Mailing Address - Zip Code:33850-2133
Mailing Address - Country:US
Mailing Address - Phone:863-662-5690
Mailing Address - Fax:863-662-5756
Practice Address - Street 1:255 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LAKE ALFRED
Practice Address - State:FL
Practice Address - Zip Code:33850-2133
Practice Address - Country:US
Practice Address - Phone:863-662-5690
Practice Address - Fax:863-662-5756
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25988225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant