Provider Demographics
NPI:1932880952
Name:ROEBUCK, CHERE LECOLE (LMT)
Entity Type:Individual
Prefix:MISS
First Name:CHERE
Middle Name:LECOLE
Last Name:ROEBUCK
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 1:714 KINGSTON DR
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75051-4446
Mailing Address - Country:US
Mailing Address - Phone:817-455-5620
Mailing Address - Fax:
Practice Address - Street 1:5930 W I 20
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1074
Practice Address - Country:US
Practice Address - Phone:817-919-7805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT133382225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist