Provider Demographics
NPI:1679843197
Name:CHARLES, CHERYL ANNE (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANNE
Last Name:CHARLES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2155 W PARK CT
Mailing Address - Street 2:SUITE G
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-3500
Mailing Address - Country:US
Mailing Address - Phone:770-465-5084
Mailing Address - Fax:770-465-5304
Practice Address - Street 1:2155 W PARK CT
Practice Address - Street 2:SUITE G
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-3500
Practice Address - Country:US
Practice Address - Phone:770-465-5084
Practice Address - Fax:770-465-5304
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT003991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist