Provider Demographics
NPI:1720050024
Name:MOSLEY, SHERRY J (MS, ATC/LAT)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:J
Last Name:MOSLEY
Suffix:
Gender:F
Credentials:MS, ATC/LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2817 N EASY ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47170-8275
Mailing Address - Country:US
Mailing Address - Phone:812-595-1350
Mailing Address - Fax:
Practice Address - Street 1:1473 N GARDNER ST
Practice Address - Street 2:
Practice Address - City:SCOTTSBURG
Practice Address - State:IN
Practice Address - Zip Code:47170-7751
Practice Address - Country:US
Practice Address - Phone:812-752-8502
Practice Address - Fax:812-752-8525
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36000766A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer