Provider Demographics
NPI:1376561423
Name:MOFFETT, CHERYL A (MPT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:MOFFETT
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:NORTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:12531 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142-6500
Mailing Address - Country:US
Mailing Address - Phone:847-659-1000
Mailing Address - Fax:847-659-1012
Practice Address - Street 1:12531 REGENCY PKWY
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142-6500
Practice Address - Country:US
Practice Address - Phone:847-659-1000
Practice Address - Fax:847-659-1012
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070008160225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00271384OtherRAILROAD MEDICARE
ILK16056Medicare UPIN
ILP00271384OtherRAILROAD MEDICARE