=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851411995
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERYL LYNN EASTBURN A.C.M.T., A.NMT.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/30/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9488 N PALOMINO DR
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80108-9223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-905-4048
-----------------------------------------------------
Fax | 303-792-9876
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9488 N PALOMINO DR
-----------------------------------------------------
City | CASTLE ROCK
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80108-9223
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-905-4048
-----------------------------------------------------
Fax | 303-792-9876
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------