Provider Demographics
NPI:1306031141
Name:BLACKWELDER, CHERYL G (LPTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:G
Last Name:BLACKWELDER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 FALCON DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-1930
Mailing Address - Country:US
Mailing Address - Phone:540-735-0260
Mailing Address - Fax:540-735-0262
Practice Address - Street 1:195 FALCON DR
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1930
Practice Address - Country:US
Practice Address - Phone:540-735-0260
Practice Address - Fax:540-735-0262
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306001121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant