Healthcare Provider Details

I. General information

NPI: 1093838443
Provider Name (Legal Business Name): CHERYL S. HAVRILESKO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5330 LAYTHAM PIKE
MAYSLICK KY
41055-8930
US

IV. Provider business mailing address

319 S MAPLE ST
WINCHESTER KY
40391-2416
US

V. Phone/Fax

Practice location:
  • Phone: 606-763-6255
  • Fax: 606-763-6245
Mailing address:
  • Phone: 606-763-6255
  • Fax: 606-763-6245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-000938
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: