Provider Demographics
NPI:1689764417
Name:SHERWOOD, JONATHAN (MSPT,ATC,MA,CSCS)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:MSPT,ATC,MA,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:STE 225
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2190
Mailing Address - Country:US
Mailing Address - Phone:510-704-7760
Mailing Address - Fax:510-704-7765
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:STE 225
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2190
Practice Address - Country:US
Practice Address - Phone:510-704-7760
Practice Address - Fax:510-704-7765
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3250552251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ25286Medicare UPIN
CAAV682ZMedicare PIN