Provider Demographics
NPI:1699189936
Name:SQUIRE, SHERI MARIE (ATC, LAT)
Entity Type:Individual
Prefix:MS
First Name:SHERI
Middle Name:MARIE
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 FORT BRAGG RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-7035
Mailing Address - Country:US
Mailing Address - Phone:910-484-1151
Mailing Address - Fax:
Practice Address - Street 1:2301 FORT BRAGG RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-7035
Practice Address - Country:US
Practice Address - Phone:910-484-1151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-14
Last Update Date:2014-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC22OtherNATIONAL ATHLETIC TRAINER'S ASSOCIATION