Provider Demographics
NPI:1851875074
Name:ANDERSON, SHERRI L (CMT)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:SHERRI
Other - Middle Name:L
Other - Last Name:JACOBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8658 VAN BUREN ST NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55434-2362
Mailing Address - Country:US
Mailing Address - Phone:763-742-9380
Mailing Address - Fax:
Practice Address - Street 1:8770 SPRINGBROOK DR NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6099
Practice Address - Country:US
Practice Address - Phone:763-742-9380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist