Provider Demographics
NPI:1811958697
Name:SHERUDA-SLATER, JENNIFER MARIE (PT MS PT DPT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:MARIE
Last Name:SHERUDA-SLATER
Suffix:
Gender:F
Credentials:PT MS PT DPT
Other - Prefix:MRS
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:SHERUDA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT MS PT DPT
Mailing Address - Street 1:334 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DICKSON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:18519-1620
Mailing Address - Country:US
Mailing Address - Phone:570-307-1769
Mailing Address - Fax:570-307-1771
Practice Address - Street 1:334 MAIN ST
Practice Address - Street 2:
Practice Address - City:DICKSON CITY
Practice Address - State:PA
Practice Address - Zip Code:18519-1620
Practice Address - Country:US
Practice Address - Phone:570-307-1769
Practice Address - Fax:570-307-1771
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098679MYQMedicare ID - Type Unspecified