Provider Demographics
NPI:1649986456
Name:MARNIEN-AVILES, CHERYL DIANNE (LMT)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:DIANNE
Last Name:MARNIEN-AVILES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:MRS
Other - First Name:CHERYL
Other - Middle Name:DIANNE
Other - Last Name:MARNIEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT
Mailing Address - Street 1:3354 LONGSHORE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19149-2030
Mailing Address - Country:US
Mailing Address - Phone:267-670-2944
Mailing Address - Fax:
Practice Address - Street 1:1825 LIMEKILN PIKE STE 5
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1739
Practice Address - Country:US
Practice Address - Phone:215-646-6400
Practice Address - Fax:215-646-0650
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011719225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist