Provider Demographics
NPI:1407041932
Name:BARDWELL, SHERRI LYNN (PTA)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:LYNN
Last Name:BARDWELL
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 1:682 FOURTH STREET
Mailing Address - Street 2:
Mailing Address - City:MEGARGEL
Mailing Address - State:TX
Mailing Address - Zip Code:76370-0682
Mailing Address - Country:US
Mailing Address - Phone:940-562-5135
Mailing Address - Fax:
Practice Address - Street 1:7330 FERN AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4971
Practice Address - Country:US
Practice Address - Phone:866-730-0707
Practice Address - Fax:866-730-0708
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2072216225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant