1720440159 NPI number — MRS. KALI ALYSS SHERRY PT,DPT, KEOMPT

Table of content: MRS. KALI ALYSS SHERRY PT,DPT, KEOMPT (NPI 1720440159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720440159 NPI number — MRS. KALI ALYSS SHERRY PT,DPT, KEOMPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERRY
Provider First Name:
KALI
Provider Middle Name:
ALYSS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT,DPT, KEOMPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720440159
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21922 ABERDEEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MACOMB
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48042-3860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-222-3009
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
72980 FULTON ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARMADA
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48005-4873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-784-6004
Provider Business Practice Location Address Fax Number:
586-784-6009
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  PT41449 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 5501017594 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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