Provider Demographics
NPI:1477184000
Name:SHERROD, EDEN BUCHANAN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:EDEN
Middle Name:BUCHANAN
Last Name:SHERROD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2667 LAWNVILLE RD
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:37763-4303
Mailing Address - Country:US
Mailing Address - Phone:865-696-1288
Mailing Address - Fax:
Practice Address - Street 1:2665 LAWNVILLE RD
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:TN
Practice Address - Zip Code:37763-4303
Practice Address - Country:US
Practice Address - Phone:865-696-1288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-02
Last Update Date:2020-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12474225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist