Provider Demographics
NPI:1659389195
Name:REMICK, CHERYL ANN (MPT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:REMICK
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:CHAMPAGNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:350 NEW FIDELITY CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-2665
Mailing Address - Country:US
Mailing Address - Phone:919-373-2919
Mailing Address - Fax:410-648-4878
Practice Address - Street 1:1033 CHAMPIONS WAY STE 500
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3775
Practice Address - Country:US
Practice Address - Phone:757-372-9953
Practice Address - Fax:757-372-9954
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22086225100000X
WYPT1003225100000X
WAPT60416675225100000X
VA2305212124225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01478265OtherRR MEDICARE PTAN
WY311755OtherBLUE CROSS BLUE SHIELD
WA0329641OtherWA L&I
WY119289200Medicaid
WA0329640OtherWA L&I
WA2038755Medicaid
WA0329640OtherWA L&I
WY9396Medicare ID - Type Unspecified
WY119289200Medicaid