Provider Demographics
NPI:1962540146
Name:BACKMAN, SHERRY (PT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 TREE HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-6324
Mailing Address - Country:US
Mailing Address - Phone:631-667-6078
Mailing Address - Fax:
Practice Address - Street 1:18 TREE HOLLOW LN
Practice Address - Street 2:
Practice Address - City:DIX HILLS
Practice Address - State:NY
Practice Address - Zip Code:11746-6324
Practice Address - Country:US
Practice Address - Phone:631-667-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011212-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist