Provider Demographics
NPI:1518013697
Name:SUENRAM, SHERRY J (PT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:SUENRAM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2352
Mailing Address - Street 2:
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81302-2352
Mailing Address - Country:US
Mailing Address - Phone:970-259-5259
Mailing Address - Fax:970-247-7810
Practice Address - Street 1:1600 FLORIDA RD
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-6836
Practice Address - Country:US
Practice Address - Phone:970-385-6969
Practice Address - Fax:970-247-7810
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1156225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO804119Medicare ID - Type Unspecified