Provider Demographics
NPI:1982733853
Name:SHERIDAN, WILLIAM (PTA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2976 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32766-5072
Mailing Address - Country:US
Mailing Address - Phone:407-365-1451
Mailing Address - Fax:
Practice Address - Street 1:7350 SANDLAKE COMMONS BLVD STE 3315
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8031
Practice Address - Country:US
Practice Address - Phone:407-354-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA18684225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant