Provider Demographics
NPI:1740250497
Name:FITZGERALD, CHERI RENEE (MPT)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:RENEE
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:681 PACIFIC COVE DR
Mailing Address - Street 2:
Mailing Address - City:PORT HUENEME
Mailing Address - State:CA
Mailing Address - Zip Code:93041-2171
Mailing Address - Country:US
Mailing Address - Phone:805-985-5758
Mailing Address - Fax:
Practice Address - Street 1:2895 LOMA VISTA RD
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-1542
Practice Address - Country:US
Practice Address - Phone:805-643-4093
Practice Address - Fax:805-643-8401
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22910225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist