Provider Demographics
NPI:1720743289
Name:CHERISME, JEAN RICHARD
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:RICHARD
Last Name:CHERISME
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:875 GRAND REGENCY POINTE UNIT 103
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4805
Mailing Address - Country:US
Mailing Address - Phone:407-283-3413
Mailing Address - Fax:
Practice Address - Street 1:875 GRAND REGENCY POINTE UNIT 103
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4805
Practice Address - Country:US
Practice Address - Phone:407-283-3413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLM97829225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist