Provider Demographics
NPI:1255345997
Name:MATIJEVICH, SHERRY WAYMAN (PT)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:WAYMAN
Last Name:MATIJEVICH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 LAKEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-5130
Mailing Address - Country:US
Mailing Address - Phone:423-748-4800
Mailing Address - Fax:
Practice Address - Street 1:1450 PIN OAK DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-1432
Practice Address - Country:US
Practice Address - Phone:423-748-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1188225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist