Basic Information
| Provider Information | |||||||||
| NPI: | 1437371861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUY | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | DARLENE | ||||||||
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| Credential: | RPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14355 TRAWICK RD | ||||||||
| Address2: | |||||||||
| City: | STAPLETON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 365784118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2512531340 | ||||||||
| FaxNumber: | 2518091715 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 SAINT JOSEPH AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BREWTON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 364262055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2518091717 | ||||||||
| FaxNumber: | 2518091715 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2007 | ||||||||
| 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 | PTH1746 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 515-29287 | 01 | AL | BLUE CROSS & BLUE SHIELD | OTHER |