Provider Demographics
NPI:1902041205
Name:WATTERSON, SHERRI J (PTA)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:J
Last Name:WATTERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1931 W DR MLK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6529
Mailing Address - Country:US
Mailing Address - Phone:813-873-9229
Mailing Address - Fax:918-873-9228
Practice Address - Street 1:1931 W DR MLK BLVD STE A
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6529
Practice Address - Country:US
Practice Address - Phone:813-873-9229
Practice Address - Fax:918-873-9228
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZPTA18295225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA18295OtherGROUP PTAN AL614