Provider Demographics
NPI:1023528403
Name:SUSHEREBA, CHERYL BETHANY
Entity type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:BETHANY
Last Name:SUSHEREBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8278 OLENTANGY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-1308
Mailing Address - Country:US
Mailing Address - Phone:814-648-1707
Mailing Address - Fax:
Practice Address - Street 1:8278 OLENTANGY RIVER RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-1308
Practice Address - Country:US
Practice Address - Phone:814-648-1707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE011418225200000X
OHPTA011538225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant