Provider Demographics
NPI:1528622339
Name:GHAVASSI, SHERRY L
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:L
Last Name:GHAVASSI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:
Other - Last Name:GHAVASSI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1138 HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-0404
Mailing Address - Country:US
Mailing Address - Phone:256-295-7705
Mailing Address - Fax:
Practice Address - Street 1:1138 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-0404
Practice Address - Country:US
Practice Address - Phone:256-295-7705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4692225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4692OtherMASSAGE THERAPIST