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General NPI Number Information
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NPI Number | 1205954583
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Entity Type | Individual
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Provider Name | CHERYL L CALDWELL PTA
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Gender | Female
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 595 PETERSON DR
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City | PHILLIPS
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State | WI
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Zip | 54555-1418
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Country | US
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Telephone | 715-339-3113
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 474
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City | ABBOTSFORD
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State | WI
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Zip | 54405-0474
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Country | US
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Telephone | 715-223-4634
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Fax |
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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 | 555-19
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License Number State | WI
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