Provider Demographics
NPI:1558311662
Name:CHERYL E. WANEK
Entity Type:Organization
Organization Name:CHERYL E. WANEK
Other - Org Name:KIDS IN MOTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:E
Authorized Official - Last Name:WANEK
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:956-630-6112
Mailing Address - Street 1:5211 N MCCOLL
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-2202
Mailing Address - Country:US
Mailing Address - Phone:956-630-6112
Mailing Address - Fax:956-683-9504
Practice Address - Street 1:5211 N MCCOLL RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-2202
Practice Address - Country:US
Practice Address - Phone:956-630-6112
Practice Address - Fax:956-683-9504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10514562251P0200X
TX18609235Z00000X
TX103428235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0626582-01Medicaid
TX042ESOtherBCBS