Provider Demographics
NPI:1841353414
Name:SPICKERMAN, CHERYL B (PT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:B
Last Name:SPICKERMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERRY
Other - Middle Name:
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6056 ROSWELL RD STE 220
Mailing Address - Street 2:CROUSE REHAB ASSOCIATES
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328
Mailing Address - Country:US
Mailing Address - Phone:404-256-5655
Mailing Address - Fax:404-256-1720
Practice Address - Street 1:6056 ROSWELL RD STE 220
Practice Address - Street 2:CROUSE REHAB ASSOCIATES
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328
Practice Address - Country:US
Practice Address - Phone:404-256-5655
Practice Address - Fax:404-256-1720
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT0318225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4895Medicare ID - Type UnspecifiedGROUP NUMBER