Provider Demographics
NPI:1699083238
Name:SHERIN, ALICIA E (LMT AND MMP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:E
Last Name:SHERIN
Suffix:
Gender:F
Credentials:LMT AND MMP
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:
Other - Last Name:SHERIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:200 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-1817
Mailing Address - Country:US
Mailing Address - Phone:817-528-0873
Mailing Address - Fax:
Practice Address - Street 1:1003 E BROAD ST
Practice Address - Street 2:SUITE 105
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-1716
Practice Address - Country:US
Practice Address - Phone:817-528-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT024296225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist