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General NPI Number Information
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NPI Number | 1306948005
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Entity Type | Individual
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Provider Name | TRACEY LEE CHERRY PT
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Gender | Female
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 12/08/2025
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Provider Practice Location Address
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Address Line | 1418 GLENDALE AVE NW
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City | PALM BAY
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State | FL
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Zip | 32907-8011
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Country | US
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Telephone | 214-548-0811
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Fax | 214-548-0811
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Provider Business Mailing Address
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Address Line | 1418 GLENDALE AVE NW
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City | PALM BAY
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State | FL
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Zip | 32907-8011
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Country | US
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Telephone | 214-548-0811
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Fax | 214-548-0811
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | PT35799
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License Number State | FL
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