Provider Demographics
NPI:1821545971
Name:PERDUE, SHERRY LYNN (BS, LAT, ATC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:LYNN
Last Name:PERDUE
Suffix:
Gender:F
Credentials:BS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:661 W CAPISTRANO AVE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-7036
Mailing Address - Country:US
Mailing Address - Phone:719-429-3476
Mailing Address - Fax:
Practice Address - Street 1:661 W CAPISTRANO AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-7036
Practice Address - Country:US
Practice Address - Phone:719-429-3476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00018112255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer