Provider Demographics
NPI:1265754709
Name:KNOWLES, SHERRY CHRISTINE (LMT)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:CHRISTINE
Last Name:KNOWLES
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 1:1158 POLK ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4056
Mailing Address - Country:US
Mailing Address - Phone:321-956-2225
Mailing Address - Fax:
Practice Address - Street 1:515 N HARBOR CITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6870
Practice Address - Country:US
Practice Address - Phone:321-956-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA11306225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist