Provider Demographics
NPI:1710014469
Name:TIMMER, CHERYL (PT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:TIMMER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:WOZNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3333 N MAYFAIR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53222-3219
Mailing Address - Country:US
Mailing Address - Phone:414-302-0770
Mailing Address - Fax:414-302-0775
Practice Address - Street 1:3333 N MAYFAIR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53222-3219
Practice Address - Country:US
Practice Address - Phone:414-302-0770
Practice Address - Fax:414-302-0775
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3215208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIQ217555Medicare UPIN
81025-0006Medicare ID - Type Unspecified