Healthcare Provider Details

I. General information

NPI: 1114189990
Provider Name (Legal Business Name): MARY SHERRIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E WASHINGTON ST
BENSENVILLE IL
60106-2674
US

IV. Provider business mailing address

1308 SPRINGWOOD DR UNIT D1
SCHAUMBURG IL
60193-5201
US

V. Phone/Fax

Practice location:
  • Phone: 630-521-8252
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.004849
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: