MEDICARE: SHERRIE LYNN DOWNEY LMT

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	225700000X	Massage Therapist	MT112341	TX

General Provider Information

NPI Number	:	1780980086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRIE LYNN DOWNEY LMT

Provider Business Mailing Address
First Line	:	209 W 2ND ST
Second Line	:	SUITE 154
City	:	FORT WORTH
State	:	TX
Zip	:	76102-3021
Country	:	US
Telephone Number	:	817-999-2543
Fax Number	:	817-392-5874

Provider Business Practice Location Address
First Line	:	4313 QUAILS LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76119-3733
Country	:	US
Telephone Number	:	817-999-2543
Fax Number	:	817-392-5874

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

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	02/03/2011

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