Provider Demographics
NPI:1578041976
Name:PYEATT, SHERIDAN EDWARD
Entity Type:Individual
Prefix:
First Name:SHERIDAN
Middle Name:EDWARD
Last Name:PYEATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 S FRONT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:CENTRAL POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97502-2779
Mailing Address - Country:US
Mailing Address - Phone:541-732-8283
Mailing Address - Fax:541-732-8207
Practice Address - Street 1:870 S FRONT ST STE 105
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2779
Practice Address - Country:US
Practice Address - Phone:541-732-8283
Practice Address - Fax:541-732-8207
Is Sole Proprietor?:No
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR052472251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic