Provider Demographics
NPI:1669018693
Name:SHERRILL, JUDSON
Entity Type:Individual
Prefix:
First Name:JUDSON
Middle Name:
Last Name:SHERRILL
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 1:3730 COUNTY ROAD 30
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-6448
Mailing Address - Country:US
Mailing Address - Phone:205-269-1185
Mailing Address - Fax:
Practice Address - Street 1:15041 HIGHWAY 43
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AL
Practice Address - Zip Code:35653-1973
Practice Address - Country:US
Practice Address - Phone:256-350-1764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-25
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT295890225100000X
ALPTH9003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist