Healthcare Provider Details

I. General information

NPI: 1992976526
Provider Name (Legal Business Name): CHERYL ELWELL PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD SUITE 129
ORLANDO FL
32825-4458
US

IV. Provider business mailing address

2529 TETON STONE RUN
ORLANDO FL
32828-7916
US

V. Phone/Fax

Practice location:
  • Phone: 407-277-5400
  • Fax: 321-281-4942
Mailing address:
  • Phone: 321-235-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number22501
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: