Provider Demographics
NPI:1255507414
Name:DEBITETTO, CHERYL J (LCMT,MMP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:J
Last Name:DEBITETTO
Suffix:
Gender:F
Credentials:LCMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 BECKLEY CIR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3912
Mailing Address - Country:US
Mailing Address - Phone:941-525-7005
Mailing Address - Fax:
Practice Address - Street 1:730 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-3524
Practice Address - Country:US
Practice Address - Phone:941-525-7005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH#2753M225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist