Provider Demographics
NPI:1578540449
Name:SHERRARD, DIANA L (PT)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:L
Last Name:SHERRARD
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 1:424 CRESTRIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-8777
Mailing Address - Country:US
Mailing Address - Phone:316-229-8279
Mailing Address - Fax:
Practice Address - Street 1:3801 S OLIVER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67210-2112
Practice Address - Country:US
Practice Address - Phone:620-262-7974
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-01290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist