Provider Demographics
NPI:1720191414
Name:SHERMAN, DIANA LEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:LEE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:LEE
Other - Last Name:SCHIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:16722 E LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:IL
Mailing Address - Zip Code:62864-7456
Mailing Address - Country:US
Mailing Address - Phone:618-237-7405
Mailing Address - Fax:
Practice Address - Street 1:1910 E MCCORD ST
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-6586
Practice Address - Country:US
Practice Address - Phone:618-533-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant