Provider Demographics
NPI:1790016210
Name:BOENIG, CHERYL (PT)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:
Last Name:BOENIG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 N WARE RD
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-3304
Mailing Address - Country:US
Mailing Address - Phone:956-688-6969
Mailing Address - Fax:956-688-6970
Practice Address - Street 1:3611 N WARE RD
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3304
Practice Address - Country:US
Practice Address - Phone:956-688-6969
Practice Address - Fax:956-688-6970
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2010-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1160500261QR0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184743601Medicaid