Provider Demographics
NPI:1417107269
Name:NELSON, SHERRY LOU (LPT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LOU
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 GREEN COVE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-2407
Mailing Address - Country:US
Mailing Address - Phone:915-833-0974
Mailing Address - Fax:
Practice Address - Street 1:6320 GATEWAY BLVD E
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79905-2006
Practice Address - Country:US
Practice Address - Phone:915-772-2111
Practice Address - Fax:915-779-6075
Is Sole Proprietor?:No
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1064087225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist