Provider Demographics
NPI:1295022143
Name:ALLEN, CHERYL LEE (LMT MLD/CDT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LMT MLD/CDT
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 W 11TH ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2480
Mailing Address - Country:US
Mailing Address - Phone:850-215-6677
Mailing Address - Fax:
Practice Address - Street 1:400 W 11TH ST
Practice Address - Street 2:SUITE F
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2480
Practice Address - Country:US
Practice Address - Phone:850-215-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA34464225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist