Healthcare Provider Details

I. General information

NPI: 1861745523
Provider Name (Legal Business Name): CHERIE LYNN COCKRELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2012
Last Update Date: 10/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701-A-1 OLSEN
AMARILLO TX
79109
US

IV. Provider business mailing address

3701-A-1 OLSEN
AMARILLO TX
79109
US

V. Phone/Fax

Practice location:
  • Phone: 806-467-8181
  • Fax: 806-467-8282
Mailing address:
  • Phone: 806-467-8181
  • Fax: 806-467-8282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number4049172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: