Provider Demographics
NPI:1225436421
Name:FABER, CHERYL (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:FABER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 DOVE CIR
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:TX
Mailing Address - Zip Code:76131-4894
Mailing Address - Country:US
Mailing Address - Phone:817-845-6022
Mailing Address - Fax:
Practice Address - Street 1:721 DUNAWAY LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2605
Practice Address - Country:US
Practice Address - Phone:817-444-2536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-12-21
Last Update Date:2014-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2030294225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant