Provider Demographics
NPI:1588744593
Name:BOWER, SHERRI LIANE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHERRI
Middle Name:LIANE
Last Name:BOWER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 S AMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92806-4926
Mailing Address - Country:US
Mailing Address - Phone:714-533-9324
Mailing Address - Fax:
Practice Address - Street 1:975 S AMBRIDGE ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4926
Practice Address - Country:US
Practice Address - Phone:714-533-9324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 3077225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant