Provider Demographics
NPI:1447340427
Name:MCLAUGHLIN, SHERRY
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2265 LIVERNOIS
Mailing Address - Street 2:SUITE 700
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-1639
Mailing Address - Country:US
Mailing Address - Phone:248-269-0230
Mailing Address - Fax:248-269-0231
Practice Address - Street 1:2265 LIVERNOIS
Practice Address - Street 2:SUITE 700
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-1639
Practice Address - Country:US
Practice Address - Phone:248-269-0230
Practice Address - Fax:248-269-0231
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501004256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI650F396850OtherBLUE CROSS BLUE SHIELD
P09750001Medicare ID - Type Unspecified
0P09750Medicare ID - Type UnspecifiedGROUP