MEDICARE: MS. MERYL SHERMAN MCCORMACK PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251G0304X	Geriatric Physical Therapist	15103	CA

General Provider Information

NPI Number	:	1093881831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MERYL SHERMAN MCCORMACK PT

Provider Business Mailing Address
First Line	:	1240 ROBYN DR
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-5049
Country	:	US
Telephone Number	:	925-838-2455
Fax Number	:	925-838-2455

Provider Business Practice Location Address
First Line	:	1240 ROBYN DR
Second Line	:
City	:	DANVILLE
State	:	CA
Zip	:	94526-5049
Country	:	US
Telephone Number	:	925-838-2455
Fax Number	:	925-838-2455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/08/2007

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