Provider Demographics
NPI:1740604198
Name:SHERMAN, SAMANTHA (PTA)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 CAROLYN RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:MI
Mailing Address - Zip Code:48625-8616
Mailing Address - Country:US
Mailing Address - Phone:989-339-0438
Mailing Address - Fax:
Practice Address - Street 1:609 CAROLYN RD
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:MI
Practice Address - Zip Code:48625-8616
Practice Address - Country:US
Practice Address - Phone:989-339-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5502003871225200000X
MI5502003871225200000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No174400000XOther Service ProvidersSpecialist