Provider Demographics
NPI:1336409168
Name:SHERRY, JOAN ELIZABETH (LCMT)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:ELIZABETH
Last Name:SHERRY
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:SHERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:408 W PERSHING BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-2541
Mailing Address - Country:US
Mailing Address - Phone:307-630-3621
Mailing Address - Fax:
Practice Address - Street 1:408 W PERSHING BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-2541
Practice Address - Country:US
Practice Address - Phone:307-630-3621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-27
Last Update Date:2012-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist