Provider Demographics
NPI:1386658946
Name:MAXWELL, CHERYL JEAN (ATC, MS, NSCA-PT)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:JEAN
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:ATC, MS, NSCA-PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COPPERFIELD LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40324-1099
Mailing Address - Country:US
Mailing Address - Phone:502-868-1096
Mailing Address - Fax:
Practice Address - Street 1:1001 CHERRY BLOSSOM WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:KY
Practice Address - Zip Code:40324-5700
Practice Address - Country:US
Practice Address - Phone:502-868-2944
Practice Address - Fax:502-868-2639
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT4782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer