=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780980086
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHERRIE LYNN DOWNEY LMT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2011
-----------------------------------------------------
Last Update Date | 02/03/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4313 QUAILS LN
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76119-3733
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-999-2543
-----------------------------------------------------
Fax | 817-392-5874
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 209 W 2ND ST SUITE 154
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76102-3021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-999-2543
-----------------------------------------------------
Fax | 817-392-5874
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MT112341
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------