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General NPI Number Information
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NPI Number | 1194846402
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Entity Type | Individual
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Provider Name | CHERYL ANN SHULOCK PTA
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Gender | Female
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2250 INDIAN CREEK BLVD W
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City | VERO BEACH
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State | FL
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Zip | 32966-1331
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Country | US
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Telephone | 772-562-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 4180 5TH ST SW
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City | VERO BEACH
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State | FL
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Zip | 32968-3909
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Country | US
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Telephone | 772-569-3270
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Fax | 772-569-0294
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 19151
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License Number State | FL
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