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General NPI Number Information
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NPI Number | 1780733154
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Entity Type | Individual
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Provider Name | CHERI M. VAN ATTA L.M.T.
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Gender | Female
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4140 BERRYHILL RD
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City | PACE
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State | FL
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Zip | 32571-8313
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Country | US
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Telephone | 850-995-7042
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Fax |
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Provider Business Mailing Address
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Address Line | 3950 HARBORS PORT ST
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City | PACE
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State | FL
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Zip | 32571-6312
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Country | US
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Telephone | 850-206-6817
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA32117
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License Number State | FL
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