Provider Demographics
NPI:1891262002
Name:CROUSE, SHERRI L (LMT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:L
Last Name:CROUSE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10100 SUNFISH RUN RD
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NY
Mailing Address - Zip Code:14772-9795
Mailing Address - Country:US
Mailing Address - Phone:716-969-2483
Mailing Address - Fax:
Practice Address - Street 1:1670 LINDQUIST DR
Practice Address - Street 2:
Practice Address - City:FALCONER
Practice Address - State:NY
Practice Address - Zip Code:14733-9714
Practice Address - Country:US
Practice Address - Phone:716-969-2483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-25
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028177-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty