Provider Demographics
NPI:1649332065
Name:SHERMAN, PAUL THEODORE (PT)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THEODORE
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 O AVE
Mailing Address - Street 2:
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2344
Mailing Address - Country:US
Mailing Address - Phone:360-588-8075
Mailing Address - Fax:360-588-0406
Practice Address - Street 1:1813 O AVE
Practice Address - Street 2:SHERMAN PHYSICAL THERAPY
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2344
Practice Address - Country:US
Practice Address - Phone:360-588-8075
Practice Address - Fax:360-588-0406
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7103484Medicaid
WA7103484Medicaid