Healthcare Provider Details

I. General information

NPI: 1902039118
Provider Name (Legal Business Name): CHERI LYNN WIELAND PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERI LYNN BATES PT, C/NDT

II. Dates (important events)

Enumeration Date: 09/03/2009
Last Update Date: 05/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3498 GREEN VALLEY RD
RESCUE CA
95672
US

IV. Provider business mailing address

3741 FOUR SPRINGS DR
RESCUE CA
95672-9552
US

V. Phone/Fax

Practice location:
  • Phone: 916-337-5587
  • Fax:
Mailing address:
  • Phone: 916-337-5587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number25931
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: