Provider Demographics
NPI:1407979149
Name:DIX, CHERYL RAYMOND (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RAYMOND
Last Name:DIX
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:KAY
Other - Last Name:RAYMOND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7301 KREUTER RD NE
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49306-9136
Mailing Address - Country:US
Mailing Address - Phone:616-874-1075
Mailing Address - Fax:
Practice Address - Street 1:7301 KREUTER RD NE
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:MI
Practice Address - Zip Code:49306-9136
Practice Address - Country:US
Practice Address - Phone:616-874-1075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002110225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist