Provider Demographics
NPI:1790223485
Name:FLETCHER, SHERRY ANN (LMT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 FOOTHILLS RD
Mailing Address - Street 2:L 18
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8657
Mailing Address - Country:US
Mailing Address - Phone:575-312-7479
Mailing Address - Fax:
Practice Address - Street 1:3500 FOOTHILLS RD
Practice Address - Street 2:L 18
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8657
Practice Address - Country:US
Practice Address - Phone:575-312-7479
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7975225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM7975OtherNEW MEXICO STATE BOARD