MEDICARE: SHERRY LYNN FADEL MS, RPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	4587	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4587	OTHER	SC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1861513483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY LYNN FADEL MS, RPT

Provider Business Mailing Address
First Line	:	9600 TWO NOTCH RD
Second Line	:	SUITE #24
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-736-5540
Fax Number	:	803-699-0951

Provider Business Practice Location Address
First Line	:	9600 TWO NOTCH RD
Second Line	:	SUITE #24
City	:	COLUMBIA
State	:	SC
Zip	:	29223-4304
Country	:	US
Telephone Number	:	803-736-5540
Fax Number	:	803-699-0951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/08/2007

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