Provider Demographics
NPI:1457359796
Name:HERRMAN, SHANA LYNNE (PT)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNNE
Last Name:HERRMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY NOEL
Other - Middle Name:
Other - Last Name:HERRMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2025 W CHEESMAN RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9760
Mailing Address - Country:US
Mailing Address - Phone:989-463-3451
Mailing Address - Fax:989-463-3451
Practice Address - Street 1:2025 W CHEESMAN RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9760
Practice Address - Country:US
Practice Address - Phone:989-463-3451
Practice Address - Fax:989-463-3451
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140866Medicare ID - Type UnspecifiedPERFORMING PROVIDER #
KS115663Medicare ID - Type UnspecifiedGROUP PROVIDER #