Provider Demographics
NPI:1528374634
Name:RALSTON, CHERYL (PTA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:RALSTON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 K 96 HWY STE B
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3012
Mailing Address - Country:US
Mailing Address - Phone:620-792-7868
Mailing Address - Fax:620-792-7867
Practice Address - Street 1:1514 K 96 HWY STE B
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3012
Practice Address - Country:US
Practice Address - Phone:620-792-7868
Practice Address - Fax:620-792-7867
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-00243225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant