MEDICARE: SHERRY STOR PTA

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	225200000X	Physical Therapy Assistant	31472	FL

General Provider Information

NPI Number	:	1215886379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY STOR PTA

Provider Business Mailing Address
First Line	:	19125 2ND CT NW
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33548-7211
Country	:	US
Telephone Number	:	904-422-7437
Fax Number	:

Provider Business Practice Location Address
First Line	:	6107 BLUE SAGE DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-2764
Country	:	US
Telephone Number	:	480-229-6810
Fax Number	:

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

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ SHERRY STOR PTA” Practice Location

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