Provider Demographics
NPI:1679812507
Name:PETROWSKI-MCDADE, SHERRIE LEE (LMT)
Entity Type:Individual
Prefix:
First Name:SHERRIE
Middle Name:LEE
Last Name:PETROWSKI-MCDADE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 NORTHAMPTON ST
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4500
Mailing Address - Country:US
Mailing Address - Phone:570-905-6967
Mailing Address - Fax:
Practice Address - Street 1:505 NORTHAMPTON ST
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-4500
Practice Address - Country:US
Practice Address - Phone:570-905-6967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-13
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG004638225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist