Provider Demographics
NPI:1316957137
Name:SHERMAN, RICHARD BRIAN (PT)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:BRIAN
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420638
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92142-0638
Mailing Address - Country:US
Mailing Address - Phone:619-665-9317
Mailing Address - Fax:
Practice Address - Street 1:4624 W POINT LOMA BLVD
Practice Address - Street 2:#13
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-1480
Practice Address - Country:US
Practice Address - Phone:619-665-9317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 26015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT26015Medicare ID - Type UnspecifiedPT PROVIDER ID # (PIN)