Provider Demographics
NPI:1235372624
Name:CLARK, CHERI LYNN (L/PTA)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:CLARK
Suffix:
Gender:F
Credentials:L/PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 FALL RIVER DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-4412
Mailing Address - Country:US
Mailing Address - Phone:970-744-3158
Mailing Address - Fax:
Practice Address - Street 1:1875 FALL RIVER DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-4412
Practice Address - Country:US
Practice Address - Phone:970-744-3158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPTA-204225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant