Provider Demographics
NPI:1639270101
Name:SHERMAN, JOANNE DEVOLL (PT)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:DEVOLL
Last Name:SHERMAN
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 1:2353 WATERFORD VILLAGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43650-8937
Mailing Address - Country:US
Mailing Address - Phone:419-570-6075
Mailing Address - Fax:
Practice Address - Street 1:3840 WOODLEY RD
Practice Address - Street 2:SUITE D
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-724-5580
Practice Address - Fax:419-724-5581
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT07759OH174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT007759OtherPHYSICAL THERAPIST LIC#
OH2419743OHMedicaid
OHSH4106911Medicare ID - Type UnspecifiedMEDICARE NUMBER