Healthcare Provider Details

I. General information

NPI: 1497001168
Provider Name (Legal Business Name): SHERYL BLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERYL RACHELLE KOHLS

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 MAIN ST STE A
REISTERSTOWN MD
21136-1248
US

IV. Provider business mailing address

25 MAIN ST STE A
REISTERSTOWN MD
21136-1248
US

V. Phone/Fax

Practice location:
  • Phone: 410-833-8300
  • Fax:
Mailing address:
  • Phone: 410-833-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT022023
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number25010
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: