Basic Information
| Provider Information | |||||||||
| NPI: | 1427426246 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KNORR | ||||||||
| FirstName: | SHERYL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.T.A | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SPERLI | ||||||||
| OtherFirstName: | SHERYL | ||||||||
| OtherMiddleName: | ANN | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 307 LAKE DR | ||||||||
| Address2: | |||||||||
| City: | RANDOM LAKE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530751764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204473041 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | N7135 ROCKY KNOLL PKWY | ||||||||
| Address2: | ROCKY KNOLL | ||||||||
| City: | PLYMOUTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530733103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204491254 | ||||||||
| FaxNumber: | 9208929256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2015 | ||||||||
| LastUpdateDate: | 09/10/2015 | ||||||||
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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 | 225200000X | 1862-19 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.