Provider Demographics
NPI:1861840050
Name:BILLINGS, CHERYL (LMT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:BILLINGS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:2706 WIDGEON LN
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5143
Mailing Address - Country:US
Mailing Address - Phone:843-222-2028
Mailing Address - Fax:
Practice Address - Street 1:2108 MCCULLOCH BLVD N
Practice Address - Street 2:
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-6665
Practice Address - Country:US
Practice Address - Phone:843-222-2028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-19888225700000X
SCMAS.3050225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist