Provider Demographics
NPI:1649340191
Name:OLDHAM, SHERI N (PTA)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:N
Last Name:OLDHAM
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 1:5818 ROYAL PALM CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45424-4410
Mailing Address - Country:US
Mailing Address - Phone:937-233-2544
Mailing Address - Fax:
Practice Address - Street 1:3122 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4004
Practice Address - Country:US
Practice Address - Phone:937-299-9337
Practice Address - Fax:937-299-9227
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA 04073225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant