Healthcare Provider Details

I. General information

NPI: 1316464316
Provider Name (Legal Business Name): JOHN MARTY CHEEKS PT, DPT, DHS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 07/21/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 MAIN ST STE 10
COLLINS MS
39428-6293
US

IV. Provider business mailing address

580 MYRICK STRENGTHFORD RD
LAUREL MS
39443-7346
US

V. Phone/Fax

Practice location:
  • Phone: 610-340-6872
  • Fax:
Mailing address:
  • Phone: 601-323-7757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT21734
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1024
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH8602
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code2251E1200X
TaxonomyErgonomics Physical Therapist
License NumberPT4356
License Number StateAR
# 5
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number07743R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: