Provider Demographics
NPI:1356096549
Name:SHERMAN, WILLIAM BLAKE (DPT)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BLAKE
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 ELLISVILLE TURNER RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-8439
Mailing Address - Country:US
Mailing Address - Phone:601-906-0249
Mailing Address - Fax:
Practice Address - Street 1:2260 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-1833
Practice Address - Country:US
Practice Address - Phone:601-399-6340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-16
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT53952251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic