Provider Demographics
NPI:1770345399
Name:BOEHLE, CHERYL D (LMT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:BOEHLE
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 1:3102 COOL MEADOW PL
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-3369
Mailing Address - Country:US
Mailing Address - Phone:414-416-8996
Mailing Address - Fax:
Practice Address - Street 1:410 JERRY ST STE 310
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-2412
Practice Address - Country:US
Practice Address - Phone:414-416-8996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT002614225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist