Provider Demographics
NPI:1588706857
Name:DEVRIES, SHERRYL LYNN (MSPT)
Entity type:Individual
Prefix:
First Name:SHERRYL
Middle Name:LYNN
Last Name:DEVRIES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 SW 165TH ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2743
Mailing Address - Country:US
Mailing Address - Phone:206-850-7508
Mailing Address - Fax:206-241-7411
Practice Address - Street 1:1605 SW 165TH ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2743
Practice Address - Country:US
Practice Address - Phone:206-850-7508
Practice Address - Fax:206-241-7411
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008215225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5598DEOtherREGENCE BLUE SHIELD
WA5539DEOtherREGENCE BLUE SHIELD
WA7132541Medicare ID - Type UnspecifiedDSHS