Basic Information
| Provider Information | |||||||||
| NPI: | 1255345997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATIJEVICH | ||||||||
| FirstName: | SHERRY | ||||||||
| MiddleName: | WAYMAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 833 LAKEWOOD DR | ||||||||
| Address2: | |||||||||
| City: | JEFFERSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 377605130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237484800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1450 PIN OAK DR | ||||||||
| Address2: | |||||||||
| City: | MORRISTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378141432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237484800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1188 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.