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General NPI Number Information
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NPI Number | 1821545971
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Entity Type | Individual
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Provider Name | SHERRY LYNN PERDUE BS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 09/07/2016
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Last Update Date | 11/05/2019
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Provider Practice Location Address
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Address Line | 661 W CAPISTRANO AVE
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City | PUEBLO WEST
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State | CO
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Zip | 81007-7036
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Country | US
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Telephone | 719-429-3476
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Fax |
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Provider Business Mailing Address
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Address Line | 661 W CAPISTRANO AVE
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City | PUEBLO WEST
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State | CO
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Zip | 81007-7036
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Country | US
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Telephone | 719-429-3476
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT.0001811
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License Number State | CO
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