Provider Demographics
NPI:1912225517
Name:VICTOR, CHERYL B (LMT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:B
Last Name:VICTOR
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1253
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77487-1253
Mailing Address - Country:US
Mailing Address - Phone:708-288-5040
Mailing Address - Fax:281-495-2524
Practice Address - Street 1:13830 PURPLEMARTIN STREET
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6866
Practice Address - Country:US
Practice Address - Phone:708-288-5040
Practice Address - Fax:281-495-2524
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT109895225700000X
IL227.005780225700000X
TX225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist