Provider Demographics
NPI:1750601530
Name:VANPATTEN, CHERYL ANN (LMT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:VANPATTEN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 STATE ROUTE 26
Mailing Address - Street 2:
Mailing Address - City:WHITNEY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:13862-1204
Mailing Address - Country:US
Mailing Address - Phone:607-692-2399
Mailing Address - Fax:
Practice Address - Street 1:5511 STATE ROUTE 26
Practice Address - Street 2:
Practice Address - City:WHITNEY POINT
Practice Address - State:NY
Practice Address - Zip Code:13862-1204
Practice Address - Country:US
Practice Address - Phone:607-692-2399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023958225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist