Provider Demographics
NPI:1558415349
Name:ANGELICH, CHERYL MARIE (PT, LAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:ANGELICH
Suffix:
Gender:F
Credentials:PT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14632 WEDDINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91411-4040
Mailing Address - Country:US
Mailing Address - Phone:818-788-0101
Mailing Address - Fax:818-234-2511
Practice Address - Street 1:5000 VAN NUYS BLVD
Practice Address - Street 2:SUITE # 210
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-788-0101
Practice Address - Fax:310-234-2511
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT10102OtherCA LICENCE