Provider Demographics
NPI:1720440159
Name:SHERRY, KALI ALYSS (PT,DPT, KEOMPT)
Entity Type:Individual
Prefix:MRS
First Name:KALI
Middle Name:ALYSS
Last Name:SHERRY
Suffix:
Gender:F
Credentials:PT,DPT, KEOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21922 ABERDEEN DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48042-3860
Mailing Address - Country:US
Mailing Address - Phone:586-222-3009
Mailing Address - Fax:
Practice Address - Street 1:14901 23 MILE RD
Practice Address - Street 2:SUITE C
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3009
Practice Address - Country:US
Practice Address - Phone:248-353-1234
Practice Address - Fax:586-566-5816
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41449225100000X
MI5501017594225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist