Provider Demographics
NPI:1891978144
Name:SIMON, CHERI S (LMT,MMP)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:S
Last Name:SIMON
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6227 PARKSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75249-3813
Mailing Address - Country:US
Mailing Address - Phone:214-664-3739
Mailing Address - Fax:
Practice Address - Street 1:6227 PARKSTONE WAY
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75249-3813
Practice Address - Country:US
Practice Address - Phone:214-664-3739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT044508225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist