Provider Demographics
NPI:1124416359
Name:DUSEK, CHERYL MARIE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:DUSEK
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 1:13611 OAKWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2340
Mailing Address - Country:US
Mailing Address - Phone:713-560-2671
Mailing Address - Fax:
Practice Address - Street 1:13611 OAKWOOD LN
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2340
Practice Address - Country:US
Practice Address - Phone:713-560-2671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1083343225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist