Healthcare Provider Details

I. General information

NPI: 1417018797
Provider Name (Legal Business Name): DAN G SHERWOOD CO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

THE FOOT PERFORMANCE CENTER 3385 BRIGHTON HENRIETTA TLR
ROCHESTER NY
14623
US

IV. Provider business mailing address

3385 BRIGHTON HEN TL RD
ROCHESTER NY
14623-2813
US

V. Phone/Fax

Practice location:
  • Phone: 585-473-5950
  • Fax: 585-473-9596
Mailing address:
  • Phone: 585-473-5950
  • Fax: 585-473-9596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: