Provider Demographics
NPI:1780336032
Name:SHERMAN, KELLY J (CPTA)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:J
Last Name:SHERMAN
Suffix:
Gender:F
Credentials:CPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1729 N BLUE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-9258
Mailing Address - Country:US
Mailing Address - Phone:316-705-5321
Mailing Address - Fax:
Practice Address - Street 1:10665 W 13TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-5600
Practice Address - Country:US
Practice Address - Phone:316-285-1348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-03501225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant