Provider Demographics
NPI:1740638246
Name:WILSON, SHERRILL LOWE (MPT)
Entity type:Individual
Prefix:
First Name:SHERRILL
Middle Name:LOWE
Last Name:WILSON
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:488 CUMBERLAND VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-1904
Mailing Address - Country:US
Mailing Address - Phone:931-260-3515
Mailing Address - Fax:
Practice Address - Street 1:675 S JEFFERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-0949
Practice Address - Country:US
Practice Address - Phone:931-528-8822
Practice Address - Fax:931-528-8825
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4963225100000X
PA8217L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist