Provider Demographics
NPI:1427031053
Name:ROBERTS, CHERYL ELLEN (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ELLEN
Last Name:ROBERTS
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 1:1008 AIRPORT RD STE A
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2822
Mailing Address - Country:US
Mailing Address - Phone:850-837-3349
Mailing Address - Fax:850-837-3158
Practice Address - Street 1:1008 AIRPORT RD STE A
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2822
Practice Address - Country:US
Practice Address - Phone:850-837-3349
Practice Address - Fax:850-837-3158
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA7150225100000X
FL29610225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist