Provider Demographics
NPI:1912065731
Name:ANDERSON, CHERYL LAFOLLETTE (PHD, PT, MBA, GCS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LAFOLLETTE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD, PT, MBA, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 RIDGEWOOD DR NW
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-4946
Mailing Address - Country:US
Mailing Address - Phone:320-762-5066
Mailing Address - Fax:
Practice Address - Street 1:4801 VETERANS DR
Practice Address - Street 2:BUILDING 48 ROOM 17
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2015
Practice Address - Country:US
Practice Address - Phone:320-255-6480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20102251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNX894276150321OtherDRIVERS LICENSE