Provider Demographics
NPI:1417437971
Name:SHERSHUN, PATRICIA (PTA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SHERSHUN
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 1:1306 MESA DRAW
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-2623
Mailing Address - Country:US
Mailing Address - Phone:210-846-7560
Mailing Address - Fax:
Practice Address - Street 1:18803 HARDY OAK BLVD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4961
Practice Address - Country:US
Practice Address - Phone:210-982-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2060869225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant