Provider Demographics
NPI:1063473007
Name:CHERRY, MICHELE F (PT)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:F
Last Name:CHERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:
Other - Last Name:FORSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:360 S PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3452
Mailing Address - Country:US
Mailing Address - Phone:720-530-6375
Mailing Address - Fax:
Practice Address - Street 1:7340 S ALTON WAY
Practice Address - Street 2:STE 11-D
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2335
Practice Address - Country:US
Practice Address - Phone:720-493-1181
Practice Address - Fax:720-493-1191
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4527225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94558230Medicaid
CO532328Medicare ID - Type Unspecified