Healthcare Provider Details

I. General information

NPI: 1164735635
Provider Name (Legal Business Name): MICHAEL A SHERWOOD L.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 WURZBACH RD
SAN ANTONIO TX
78240-1041
US

IV. Provider business mailing address

9814 AUTUMN VLY
CONVERSE TX
78109-4612
US

V. Phone/Fax

Practice location:
  • Phone: 210-658-0840
  • Fax:
Mailing address:
  • Phone: 210-658-0840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT011730
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: