Provider Demographics
NPI:1386179356
Name:MUZZY, SHERI (LMT)
Entity Type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:MUZZY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 W SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5330
Mailing Address - Country:US
Mailing Address - Phone:217-372-4255
Mailing Address - Fax:
Practice Address - Street 1:3025 W SUMMIT DR
Practice Address - Street 2:
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5330
Practice Address - Country:US
Practice Address - Phone:217-372-4255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015008996225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist