Provider Demographics
NPI:1598247363
Name:WILSON-SIMS, SHERRI LYNN (PTA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:LYNN
Last Name:WILSON-SIMS
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 1:16603 N QUADRANT CT
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:TX
Mailing Address - Zip Code:77532-4933
Mailing Address - Country:US
Mailing Address - Phone:918-766-1663
Mailing Address - Fax:
Practice Address - Street 1:310 E LAWRENCE ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-1805
Practice Address - Country:US
Practice Address - Phone:936-258-7227
Practice Address - Fax:936-258-7223
Is Sole Proprietor?:No
Enumeration Date:2018-08-29
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2092759225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant