Provider Demographics
NPI:1679555338
Name:SHERMAN, SUSAN F (PT)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:F
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 1:99 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:99 CHESTNUT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7585
Practice Address - Country:US
Practice Address - Phone:617-735-0854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1831225100000X
MEPT2141225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA57786HPOtherHARVARD PILGRIM HEALTH
MAY65164OtherBLUECROSS BLUE SHIELD
MA0349127Medicaid
MAY65164OtherBLUECROSS BLUE SHIELD