MEDICARE: SHERI LYNN WHITE-HACKLEY 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	225100000X	Physical Therapist	PT14632	CA

General Provider Information

NPI Number	:	1306098108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERI LYNN WHITE-HACKLEY PT

Provider Business Mailing Address
First Line	:	31740 CEDAR ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3922
Country	:	US
Telephone Number	:	707-961-1606
Fax Number	:

Provider Business Practice Location Address
First Line	:	31740 CEDAR ST
Second Line	:
City	:	FORT BRAGG
State	:	CA
Zip	:	95437-3922
Country	:	US
Telephone Number	:	707-961-1606
Fax Number	:

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

Provider Enumeration Date	:	10/13/2008
Last Update Date	:	10/13/2008

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