Healthcare Provider Details

I. General information

NPI: 1891071510
Provider Name (Legal Business Name): HEATHER ANN SHERMAN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1987 STATE ROUTE 52 SUITE 11
LIBERTY NY
12754-8316
US

IV. Provider business mailing address

1987 STATE ROUTE 52 SUITE 11
LIBERTY NY
12754-8316
US

V. Phone/Fax

Practice location:
  • Phone: 845-292-8580
  • Fax: 845-292-8909
Mailing address:
  • Phone: 845-292-8580
  • Fax: 845-292-8909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number034186-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: