Provider Demographics
NPI:1619176534
Name:ROURK, CHERI MIDDLETON
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:MIDDLETON
Last Name:ROURK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:M
Other - Last Name:MIDDLETON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2221 PEACHTREE RD NE
Mailing Address - Street 2:STE D336
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1148
Mailing Address - Country:US
Mailing Address - Phone:770-443-4483
Mailing Address - Fax:770-443-4410
Practice Address - Street 1:2221 PEACHTREE RD NE
Practice Address - Street 2:STE D336
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1148
Practice Address - Country:US
Practice Address - Phone:770-443-4483
Practice Address - Fax:770-443-4410
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004679225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5111650003Medicare PIN