Provider Demographics
NPI:1861025462
Name:SHERMAN, TANYA DESIRAE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:DESIRAE
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5001 W WADLEY AVE APT D311
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79707-5143
Mailing Address - Country:US
Mailing Address - Phone:432-230-9951
Mailing Address - Fax:
Practice Address - Street 1:1301 DOTSY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79763-3576
Practice Address - Country:US
Practice Address - Phone:432-456-0029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-21
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT81622255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22OtherRESPIRATORY, REHABILITATIVE, AND RESTORATIVE SERVICE PROVIDERS