Healthcare Provider Details

I. General information

NPI: 1447441399
Provider Name (Legal Business Name): CHERYL S ROTHROCK LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date: 01/19/2024
Reactivation Date: 07/28/2026

III. Provider practice location address

12650 DEL WEBB BLVD
SUMMERFIELD FL
34491-9469
US

IV. Provider business mailing address

PO BOX 923
SUMMERFIELD FL
34492-0923
US

V. Phone/Fax

Practice location:
  • Phone: 352-454-3236
  • Fax:
Mailing address:
  • Phone: 352-454-3236
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA50935
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: