Healthcare Provider Details

I. General information

NPI: 1013547462
Provider Name (Legal Business Name): SHERRY KATE SPRINGFIELD LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2020
Last Update Date: 01/23/2020
Certification Date: 01/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N WOODBURN DR
DOTHAN AL
36303-2015
US

IV. Provider business mailing address

501 N WOODBURN DR
DOTHAN AL
36303-2015
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-1000
  • Fax:
Mailing address:
  • Phone: 334-794-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA4181
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: