Provider Demographics
NPI:1801085386
Name:SHERWOOD, SANDRA KAY (PTA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:SHERWOOD
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:PO BOX 636
Mailing Address - Street 2:
Mailing Address - City:HOLLY
Mailing Address - State:CO
Mailing Address - Zip Code:81047-0636
Mailing Address - Country:US
Mailing Address - Phone:719-537-6555
Mailing Address - Fax:719-537-0142
Practice Address - Street 1:320 N. 8TH ST.
Practice Address - Street 2:
Practice Address - City:HOLLY
Practice Address - State:CO
Practice Address - Zip Code:81047-9787
Practice Address - Country:US
Practice Address - Phone:719-537-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00649225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant