Provider Demographics
NPI:1982015327
Name:CHERIAN, DEEPU
Entity Type:Individual
Prefix:
First Name:DEEPU
Middle Name:
Last Name:CHERIAN
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 1:7609 CARLTON ARMS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33884-4810
Mailing Address - Country:US
Mailing Address - Phone:734-502-8343
Mailing Address - Fax:
Practice Address - Street 1:7609 CARLTON ARMS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33884-4810
Practice Address - Country:US
Practice Address - Phone:734-502-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-19
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT29901225100000X
MI5501015068225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist