Provider Demographics
NPI:1700254943
Name:WHEATON, SHERRY (PTA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:WHEATON
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 1:501 LEMANS DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-3092
Mailing Address - Country:US
Mailing Address - Phone:863-382-1613
Mailing Address - Fax:
Practice Address - Street 1:501 LEMANS DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-3092
Practice Address - Country:US
Practice Address - Phone:863-382-1613
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA 28571225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant