Provider Demographics
NPI:1922585173
Name:ANDERSON, CHERIE J (PTA)
Entity Type:Individual
Prefix:
First Name:CHERIE
Middle Name:J
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9515 E 51ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-9053
Mailing Address - Country:US
Mailing Address - Phone:918-622-7488
Mailing Address - Fax:208-777-4020
Practice Address - Street 1:9515 E 51ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-9053
Practice Address - Country:US
Practice Address - Phone:918-622-7488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-20
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPTA-5854225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDPTA-5854OtherIDAHP BOARD OF OCCUPATIONAL LICENCE