Provider Demographics
NPI:1831543032
Name:REW, CHERYL
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:REW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN-CELINE
Other - Last Name:CZERWONKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:50475 GRATIOT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48051-3128
Mailing Address - Country:US
Mailing Address - Phone:586-598-0050
Mailing Address - Fax:586-598-1804
Practice Address - Street 1:50475 GRATIOT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48051-3128
Practice Address - Country:US
Practice Address - Phone:586-598-0050
Practice Address - Fax:586-598-1804
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-14
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002972225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI236576OtherMEDICARE PROVIDER NUMBER