Healthcare Provider Details

I. General information

NPI: 1336674225
Provider Name (Legal Business Name): CHERYL LAHTI I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 E WASHINGTON ST
SAINT LOUIS MI
48880-1980
US

IV. Provider business mailing address

427 E WASHINGTON ST
SAINT LOUIS MI
48880-1980
US

V. Phone/Fax

Practice location:
  • Phone: 989-681-5721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number5502001681
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: