Provider Demographics
NPI:1821110651
Name:NIX, CHERITA ROBERTA (DPT)
Entity Type:Individual
Prefix:MS
First Name:CHERITA
Middle Name:ROBERTA
Last Name:NIX
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 52
Mailing Address - Street 2:166 5TH STREET
Mailing Address - City:CLYO
Mailing Address - State:GA
Mailing Address - Zip Code:31303
Mailing Address - Country:US
Mailing Address - Phone:912-601-7155
Mailing Address - Fax:
Practice Address - Street 1:100 FRIST CT
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-3578
Practice Address - Country:US
Practice Address - Phone:706-494-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002190225200000X
SC8317225100000X
GAPT012335225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant