Healthcare Provider Details

I. General information

NPI: 1871714006
Provider Name (Legal Business Name): SHERRIE STAMPS BROWN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 HALTIWANGER RD
GREENWOOD SC
29649-1799
US

IV. Provider business mailing address

2222 SULLIVAN TRL
EASTON PA
18040-7958
US

V. Phone/Fax

Practice location:
  • Phone: 864-943-1933
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2109
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: