Provider Demographics
NPI:1760777312
Name:WALLIS, SHERRI BETH (PT)
Entity Type:Individual
Prefix:MS
First Name:SHERRI
Middle Name:BETH
Last Name:WALLIS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7214 COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:CRANDALL
Mailing Address - State:TX
Mailing Address - Zip Code:75114-3425
Mailing Address - Country:US
Mailing Address - Phone:972-489-2836
Mailing Address - Fax:
Practice Address - Street 1:701 MCCLINTIC DR
Practice Address - Street 2:
Practice Address - City:GROESBECK
Practice Address - State:TX
Practice Address - Zip Code:76642-2128
Practice Address - Country:US
Practice Address - Phone:254-729-3281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-11
Last Update Date:2011-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1097509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist