Provider Demographics
NPI:1275916868
Name:NOBREGA, CHERYL ANN (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:NOBREGA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5120 LYDIA CT
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34608-2628
Mailing Address - Country:US
Mailing Address - Phone:352-592-1114
Mailing Address - Fax:352-592-1190
Practice Address - Street 1:11463 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-7367
Practice Address - Country:US
Practice Address - Phone:352-592-1114
Practice Address - Fax:352-592-1190
Is Sole Proprietor?:No
Enumeration Date:2015-07-01
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 28924225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT 28924OtherFLORIDA PHYSICAL THERAPY LICENSE
FLIG565ZMedicare PIN
FLIG565XMedicare PIN
FLIG565YMedicare PIN