Provider Demographics
NPI:1902039118
Name:WIELAND, CHERI LYNN (PT)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:LYNN
Last Name:WIELAND
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:LYNN
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, C/NDT
Mailing Address - Street 1:3741 FOUR SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-9552
Mailing Address - Country:US
Mailing Address - Phone:916-337-5587
Mailing Address - Fax:
Practice Address - Street 1:3498 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672
Practice Address - Country:US
Practice Address - Phone:916-337-5587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-03
Last Update Date:2018-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA259312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics