Provider Demographics
NPI:1275878969
Name:WANDREY, CHERYL LYNN (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:WANDREY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYNN
Other - Last Name:LINDSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2222 SULLIVAN TRL
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18040-7958
Mailing Address - Country:US
Mailing Address - Phone:800-944-9782
Mailing Address - Fax:610-438-2046
Practice Address - Street 1:1035 MADISON ST
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60302-4449
Practice Address - Country:US
Practice Address - Phone:708-848-7200
Practice Address - Fax:708-660-9193
Is Sole Proprietor?:No
Enumeration Date:2012-12-06
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.012220225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist