Provider Demographics
NPI:1538438965
Name:MORAN, SHERRY LYNN (LPTA)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LYNN
Last Name:MORAN
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53545-3132
Mailing Address - Country:US
Mailing Address - Phone:608-295-5450
Mailing Address - Fax:
Practice Address - Street 1:700 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53545-3132
Practice Address - Country:US
Practice Address - Phone:608-295-5450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI858-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant