Provider Demographics
NPI:1891135539
Name:LORD, SHERRY (PT)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:LORD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 SUDBROOK LN
Mailing Address - Street 2:STE A
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4130
Mailing Address - Country:US
Mailing Address - Phone:410-358-1997
Mailing Address - Fax:866-840-6040
Practice Address - Street 1:115 SUDBROOK LN
Practice Address - Street 2:STE A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-4130
Practice Address - Country:US
Practice Address - Phone:410-358-1997
Practice Address - Fax:866-840-6040
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251782251P0200X
VA23050040892251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4978056Medicaid