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General NPI Number Information
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NPI Number | 1528131349
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Entity Type | Individual
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Provider Name | CHERYL B. VANDEMARK PT
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 02/15/2019
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Provider Practice Location Address
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Address Line | 3117 STILLWATER DRIVE
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City | PRESCOTT
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State | AZ
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Zip | 86305
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Country | US
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Telephone | 928-442-0005
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Fax | 928-442-0660
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Provider Business Mailing Address
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Address Line | 411 W ROAD 1 N STE A
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City | CHINO VALLEY
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State | AZ
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Zip | 86323-5943
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Country | US
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Telephone | 928-442-0005
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Fax | 928-442-0660
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1743
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License Number State | AZ
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