Provider Demographics
NPI:1972621332
Name:EBETINO, SHERRI J (PTA)
Entity type:Individual
Prefix:
First Name:SHERRI
Middle Name:J
Last Name:EBETINO
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 1:3624 J DEWEY GRAY CIR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-6584
Mailing Address - Country:US
Mailing Address - Phone:706-210-7529
Mailing Address - Fax:706-312-7610
Practice Address - Street 1:1706 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909
Practice Address - Country:US
Practice Address - Phone:706-210-7529
Practice Address - Fax:706-312-7610
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA002231225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant