Healthcare Provider Details

I. General information

NPI: 1821631474
Provider Name (Legal Business Name): SHERRY J MILLER MASSAGE THERAPIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 BRENTSHIRE SQ STE A
JACKSON TN
38305-2203
US

IV. Provider business mailing address

18 BRENTSHIRE SQ STE A
JACKSON TN
38305-2203
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-7465
  • Fax:
Mailing address:
  • Phone: 731-300-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374K00000X
TaxonomyReligious Nonmedical Practitioner
License NumberSG5HWCME
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number86913
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number8305
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: