Provider Demographics
NPI:1013967256
Name:WANEK, CHERYL E (PT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:E
Last Name:WANEK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9101 BURNET RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5254
Mailing Address - Country:US
Mailing Address - Phone:512-248-2422
Mailing Address - Fax:512-248-2354
Practice Address - Street 1:4607 MENCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1607
Practice Address - Country:US
Practice Address - Phone:512-916-1511
Practice Address - Fax:512-916-1532
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1429-24225100000X
TX1051456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
84340TOtherBLUE CROSS BLUE SHIELD
TX0626582-01Medicaid
122582OtherSUPERIOR HEALTHPLAN