Provider Demographics
NPI:1376055764
Name:IRVIN, CHERYL (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:IRVIN
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 1:1705 SE BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:ALBERT LEA
Mailing Address - State:MN
Mailing Address - Zip Code:56007-3265
Mailing Address - Country:US
Mailing Address - Phone:507-668-2900
Mailing Address - Fax:
Practice Address - Street 1:1705 SE BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-3265
Practice Address - Country:US
Practice Address - Phone:507-668-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-25
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5119225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist