Provider Demographics
NPI:1265215503
Name:CHILDRESS, SCHERRI DIANE (PTA)
Entity type:Individual
Prefix:
First Name:SCHERRI
Middle Name:DIANE
Last Name:CHILDRESS
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 1:2402 MILAM ST APT 4201
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006-2364
Mailing Address - Country:US
Mailing Address - Phone:512-217-5740
Mailing Address - Fax:
Practice Address - Street 1:2401 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77021-2023
Practice Address - Country:US
Practice Address - Phone:713-741-8701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2176585225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant