Provider Demographics
NPI:1093831653
Name:BURR, CHERYL DENISE (PT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:DENISE
Last Name:BURR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2110 FOX DRIVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820
Mailing Address - Country:US
Mailing Address - Phone:217-355-1616
Mailing Address - Fax:217-355-2620
Practice Address - Street 1:220 FORT JESSE ROAD
Practice Address - Street 2:SUITE 250
Practice Address - City:NORMAL
Practice Address - State:IL
Practice Address - Zip Code:61761
Practice Address - Country:US
Practice Address - Phone:309-454-1616
Practice Address - Fax:309-454-5167
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070013049225100000X
IL070.013049225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203OtherBLUE CROSS PROV ID
113326OtherHEALTHLINK PROV ID
7216OtherPERSONALCARE PROV ID
IL4117OtherHAMP PROVIDER ID
7216OtherPERSONALCARE PROV ID