Provider Demographics
NPI:1114132966
Name:AUGUST, CHERLYN MICHELLE
Entity Type:Individual
Prefix:
First Name:CHERLYN
Middle Name:MICHELLE
Last Name:AUGUST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2838 SHELLHART RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-6362
Mailing Address - Country:US
Mailing Address - Phone:330-825-2254
Mailing Address - Fax:
Practice Address - Street 1:1440 SNOW RD
Practice Address - Street 2:SUITE 308
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-2774
Practice Address - Country:US
Practice Address - Phone:888-782-4656
Practice Address - Fax:216-929-2903
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA. 05173225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant