Provider Demographics
NPI:1427250158
Name:WOODVILLE, CHERYL L (CF-ORTHOTICS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:WOODVILLE
Suffix:
Gender:F
Credentials:CF-ORTHOTICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1253 MANGROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3527
Mailing Address - Country:US
Mailing Address - Phone:530-899-2727
Mailing Address - Fax:530-899-2730
Practice Address - Street 1:1253 MANGROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-3527
Practice Address - Country:US
Practice Address - Phone:530-899-2727
Practice Address - Fax:530-899-2730
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44349174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5979440001Medicare NSC