Basic Information
| Provider Information | |||||||||
| NPI: | 1225248552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEVERIDGE | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | GRAHAM | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 337 LANDS ML SE | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300675178 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709558737 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2155 POST OAK TRITT RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300628620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705654044 | ||||||||
| FaxNumber: | 7705655653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT001703 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.