MEDICARE: CHERIL EVANGELISTA CARREON SANCHEZ P.T.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	24699	FL

General Provider Information

NPI Number	:	1386874709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERIL EVANGELISTA CARREON SANCHEZ P.T.

Provider Business Mailing Address
First Line	:	11950 WYNNFIELD LAKES CIR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-4232
Country	:	US
Telephone Number	:	562-606-7515
Fax Number	:

Provider Business Practice Location Address
First Line	:	10660 OLD SAINT AUGUSTINE RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1076
Country	:	US
Telephone Number	:	904-268-3447
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	05/17/2012

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