Healthcare Provider Details

I. General information

NPI: 1932374287
Provider Name (Legal Business Name): SHERRY HAWSON PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 02/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 MAIN STREET
CHILHOWIE VA
24319
US

IV. Provider business mailing address

940 E LEE HIGHWAY
CHILHOWIE VA
24319
US

V. Phone/Fax

Practice location:
  • Phone: 276-646-8911
  • Fax:
Mailing address:
  • Phone: 276-646-8911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA15675
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: