Provider Demographics
NPI:1689610768
Name:HANKS, CHERYL J (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:J
Last Name:HANKS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:J
Other - Last Name:HANKS OPSATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4720 EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503
Mailing Address - Country:US
Mailing Address - Phone:310-214-9730
Mailing Address - Fax:310-214-9730
Practice Address - Street 1:1300 W 155TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247
Practice Address - Country:US
Practice Address - Phone:310-329-1444
Practice Address - Fax:310-329-9586
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2017-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WPT26214BMedicare ID - Type Unspecified
WPT26214AMedicare ID - Type Unspecified