Provider Demographics
NPI:1326683335
Name:BERRY, CHERYL LEN (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEN
Last Name:BERRY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NICHOLAS PKWY W # 105
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33991-2845
Mailing Address - Country:US
Mailing Address - Phone:239-424-9904
Mailing Address - Fax:239-317-0268
Practice Address - Street 1:58 NICHOLAS PKWY W # 105
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2845
Practice Address - Country:US
Practice Address - Phone:239-424-9904
Practice Address - Fax:239-317-0268
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT11205225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPT11205OtherMEDICAL LICENSE