Provider Demographics
NPI:1821631474
Name:MILLER, SHERRY J (MASSAGE THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:J
Last Name:MILLER
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 BRENTSHIRE SQ STE A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2203
Mailing Address - Country:US
Mailing Address - Phone:731-300-7465
Mailing Address - Fax:
Practice Address - Street 1:18 BRENTSHIRE SQ STE A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2203
Practice Address - Country:US
Practice Address - Phone:731-300-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-25
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSG5HWCME374K00000X
TN86913376K00000X
TN8305225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Single Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty