Provider Demographics
NPI:1578646550
Name:CHERRY, TIMOTHY BROOKS (ATC)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:BROOKS
Last Name:CHERRY
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 BRIARGATE WAY
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3097
Mailing Address - Country:US
Mailing Address - Phone:931-525-2036
Mailing Address - Fax:
Practice Address - Street 1:315 OAK ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1728
Practice Address - Country:US
Practice Address - Phone:931-823-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN00000007872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer