Provider Demographics
NPI:1518742543
Name:HANKE, SHERMAN (LMT)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:
Last Name:HANKE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FERNALD DR APT 31
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1430
Mailing Address - Country:US
Mailing Address - Phone:617-331-3133
Mailing Address - Fax:
Practice Address - Street 1:379 MAIN ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6256
Practice Address - Country:US
Practice Address - Phone:617-331-3133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8444225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist