Provider Demographics
NPI:1184886418
Name:SALAZAR, CHERRY M (PT)
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:M
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4920 N CENTRAL AVE STE 1C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-2342
Mailing Address - Country:US
Mailing Address - Phone:773-250-8911
Mailing Address - Fax:773-205-6481
Practice Address - Street 1:4920 N CENTRAL AVE STE 1C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-2342
Practice Address - Country:US
Practice Address - Phone:773-250-8911
Practice Address - Fax:773-205-6481
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070015165225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist