Provider Demographics
NPI:1366871337
Name:SHERRILL, BLAIR KRISTEN (PT)
Entity type:Individual
Prefix:
First Name:BLAIR
Middle Name:KRISTEN
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BLAIR
Other - Middle Name:K
Other - Last Name:BARNHILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1619 PLANTATION
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-5246
Mailing Address - Country:US
Mailing Address - Phone:870-421-1924
Mailing Address - Fax:
Practice Address - Street 1:1310 BRADLEY DR
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-2730
Practice Address - Country:US
Practice Address - Phone:870-424-4021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3787225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist