Provider Demographics
NPI:1902041403
Name:CABRERA, SRI SHERMAN BACALA (PT)
Entity Type:Individual
Prefix:
First Name:SRI SHERMAN
Middle Name:BACALA
Last Name:CABRERA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD
Mailing Address - Street 2:SUITE 290 EXECUTIVE CENTER II
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-750-9006
Mailing Address - Fax:410-750-0787
Practice Address - Street 1:3290 N RIDGE RD
Practice Address - Street 2:SUITE 290 EXECUTIVE CENTER II
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3655
Practice Address - Country:US
Practice Address - Phone:410-750-9006
Practice Address - Fax:410-750-0787
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist