Provider Demographics
NPI:1821602525
Name:CHERY, JEAN E
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:E
Last Name:CHERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 W LAKE MIRAMAR CIR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4808
Mailing Address - Country:US
Mailing Address - Phone:954-391-3847
Mailing Address - Fax:
Practice Address - Street 1:2330 W LAKE MIRAMAR CIR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-4808
Practice Address - Country:US
Practice Address - Phone:954-391-3847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL86472225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist