Provider Demographics
NPI:1891832705
Name:SOTHERAN, SHEREE LYNN (RPT)
Entity Type:Individual
Prefix:MS
First Name:SHEREE
Middle Name:LYNN
Last Name:SOTHERAN
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 NORTHPOINT AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068-1286
Mailing Address - Country:US
Mailing Address - Phone:816-792-2256
Mailing Address - Fax:816-792-2256
Practice Address - Street 1:708 NORTHPOINT AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068-1286
Practice Address - Country:US
Practice Address - Phone:816-792-2256
Practice Address - Fax:816-792-2256
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR1173225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist