Provider Demographics
NPI:1104078757
Name:EDWARDS, SHERIE MAE (PT)
Entity type:Individual
Prefix:MS
First Name:SHERIE
Middle Name:MAE
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 CORPORATE DR
Mailing Address - Street 2:STE 400
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-8923
Mailing Address - Fax:423-954-7399
Practice Address - Street 1:1300 BRIDGE BARRIER RD
Practice Address - Street 2:BLVD 3
Practice Address - City:CAROLINA BEACH
Practice Address - State:NC
Practice Address - Zip Code:28428-3938
Practice Address - Country:US
Practice Address - Phone:910-458-8884
Practice Address - Fax:910-458-3976
Is Sole Proprietor?:No
Enumeration Date:2008-10-15
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9407225100000X
NCP16349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAED Y69394Medicare PIN