Basic Information
Provider Information
NPI: 1285923128
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERROW
FirstName: ANGELA
MiddleName: DAWN
NamePrefix: MRS.
NameSuffix:  
Credential: P.T.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7733 FORSYTH BLVD
Address2: SUITE 2300
City: SAINT LOUIS
State: MO
PostalCode: 631051817
CountryCode: US
TelephoneNumber: 8006771238
FaxNumber: 3148630769
Practice Location
Address1: 2071 VILLAGE
Address2:  
City: HERMANN
State: MO
PostalCode: 65041
CountryCode: US
TelephoneNumber: 5734865060
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2011
LastUpdateDate: 03/31/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X112660MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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