Provider Demographics
NPI:1821381617
Name:SHERMAN, ANDREW D (PT)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:D
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HASTINGS AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2303
Mailing Address - Country:US
Mailing Address - Phone:805-340-4103
Mailing Address - Fax:
Practice Address - Street 1:53 HASTINGS AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2303
Practice Address - Country:US
Practice Address - Phone:805-340-4103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26014225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA056608OtherMEDICARE PROVIDER ID