Wallace M Sheridan Jr, PT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

1096907 Issued in TX

Practice address

5415 Lost LN
San Antonio, TX 78238-2754

Phone

(210) 448-9111

Fax

(210) 308-9595

NPI assigned

Dec 8, 2009

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349136000000",
    "number": "1881923647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5415 LOST LN",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782382754",
            "telephone_number": "210-448-9111",
            "fax_number": "210-308-9595"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5415 LOST LN",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782382754",
            "telephone_number": "210-448-9111",
            "fax_number": "210-308-9595"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERIDAN JR",
        "first_name": "WALLACE",
        "middle_name": "M",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-08",
        "last_updated": "2012-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "TX",
            "license": "1096907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• India Sheppard
• Melinda Sheppard, M.A. L.P.C.
• Kelsey K. Sherburne, M.D.
• Sheri Simonds Earley DC PLLC (Huebner Chiropractic)
• Kurt James Sherick, MD
• Priscilla Sheridan-Roberson, LMFT-A
• Kathryn S Sheridan, RD
• Paul Sheridan, DDS
• Shelby A Sheridan, RN
• Warren Martin Sheridan Jr., M.A., LPC-A

• Physical Therapist in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Physical Therapist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.