Provider Demographics
NPI:1164024014
Name:PURYEAR, CHERON MARCELL (PT)
Entity Type:Individual
Prefix:
First Name:CHERON
Middle Name:MARCELL
Last Name:PURYEAR
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-258-2714
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:5078 WILLIAMSPORT PIKE STE I
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25404-6458
Practice Address - Country:US
Practice Address - Phone:304-271-8895
Practice Address - Fax:304-271-8891
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213941225100000X
WV225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist