Healthcare Provider Details

I. General information

NPI: 1316270820
Provider Name (Legal Business Name): CHERYL LYNN SHEETS LPTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5940 NEUMAN RD
SAINT CLAIR MI
48079-3221
US

IV. Provider business mailing address

5940 NEUMAN RD
SAINT CLAIR MI
48079-3221
US

V. Phone/Fax

Practice location:
  • Phone: 810-531-5169
  • Fax:
Mailing address:
  • Phone: 810-531-5169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number160.004188
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: