Provider Demographics
NPI:1427426246
Name:KNORR, SHERYL ANN (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHERYL
Middle Name:ANN
Last Name:KNORR
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:SHERYL
Other - Middle Name:ANN
Other - Last Name:SPERLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:RANDOM LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:53075-1764
Mailing Address - Country:US
Mailing Address - Phone:920-447-3041
Mailing Address - Fax:
Practice Address - Street 1:N7135 ROCKY KNOLL PKWY
Practice Address - Street 2:ROCKY KNOLL
Practice Address - City:PLYMOUTH
Practice Address - State:WI
Practice Address - Zip Code:53073-3103
Practice Address - Country:US
Practice Address - Phone:920-449-1254
Practice Address - Fax:920-892-9256
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1862-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant