Provider Demographics
NPI:1104269364
Name:TRAN, SHERRY (LMT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:TRAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 NW MT WASHINGTON DR
Mailing Address - Street 2:SUITE 307
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-1574
Mailing Address - Country:US
Mailing Address - Phone:541-633-5160
Mailing Address - Fax:
Practice Address - Street 1:745 NW MT WASHINGTON DR
Practice Address - Street 2:SUITE 307
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-1574
Practice Address - Country:US
Practice Address - Phone:541-633-5160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2014-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16603225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist