MEDICARE: DR. SHERRI MARIE LORRAINE PHD, DPT

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	22630	FL

General Provider Information

NPI Number	:	1508041765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRI MARIE LORRAINE PHD, DPT

Provider Business Mailing Address
First Line	:	1130 S HARBOR CITY BLVD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1966
Country	:	US
Telephone Number	:	321-914-4211
Fax Number	:	321-914-4212

Provider Business Practice Location Address
First Line	:	1130 S HARBOR CITY BLVD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32901-1966
Country	:	US
Telephone Number	:	321-914-4211
Fax Number	:	321-914-4212

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

Provider Enumeration Date	:	01/07/2008
Last Update Date	:	02/22/2012

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