Healthcare Provider Details

I. General information

NPI: 1952397002
Provider Name (Legal Business Name): CHERISSE MARY SANSONE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 07/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 N. MAIN ST.
CLAYTON GA
30525-3020
US

IV. Provider business mailing address

PO BOX 1397
CLAYTON GA
30525-0035
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-2585
  • Fax: 706-782-2012
Mailing address:
  • Phone: 706-782-2585
  • Fax: 706-782-2012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006931
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: