Provider Demographics
NPI:1922484427
Name:SHERRY, JENNA MAE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:MAE
Last Name:SHERRY
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 PRAIRIE LN
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-1572
Mailing Address - Country:US
Mailing Address - Phone:419-796-8335
Mailing Address - Fax:419-399-3346
Practice Address - Street 1:202 N.CHERRY ST.
Practice Address - Street 2:WESTERN BUCKEYE ESC
Practice Address - City:PAULDING
Practice Address - State:OH
Practice Address - Zip Code:45879
Practice Address - Country:US
Practice Address - Phone:419-399-4711
Practice Address - Fax:419-399-3346
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT015570225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist