Provider Demographics
NPI:1427140532
Name:MAXWELL, SHERI (PT)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAYSON NEW HOPE RD
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-4316
Mailing Address - Country:US
Mailing Address - Phone:770-682-3854
Mailing Address - Fax:770-682-3824
Practice Address - Street 1:20 NEW HOPE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:GA
Practice Address - Zip Code:30017-4316
Practice Address - Country:US
Practice Address - Phone:770-682-3854
Practice Address - Fax:770-682-3824
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0106012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS70563Medicare UPIN
CAWPT18920AMedicare ID - Type UnspecifiedSHERI PETERSON