Basic Information
Provider Information
NPI: 1891747861
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JENKINS-WEILER
FirstName: SHERRY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1020 MARY ST
Address2:  
City: UTICA
State: NY
PostalCode: 135011930
CountryCode: US
TelephoneNumber: 3157246907
FaxNumber: 3157330791
Practice Location
Address1: 1427 GENESEE ST
Address2:  
City: UTICA
State: NY
PostalCode: 135014343
CountryCode: US
TelephoneNumber: 3157381428
FaxNumber: 3157381461
Other Information
ProviderEnumerationDate: 05/17/2006
LastUpdateDate: 01/04/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/04/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X019027-1NYY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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