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General NPI Number Information
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NPI Number | 1902039118
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Entity Type | Individual
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Provider Name | CHERI LYNN WIELAND PT
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Gender | Female
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Dates
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Enumeration Date | 09/03/2009
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Last Update Date | 05/20/2018
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Provider Practice Location Address
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Address Line | 3498 GREEN VALLEY RD
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City | RESCUE
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State | CA
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Zip | 95672
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Country | US
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Telephone | 916-337-5587
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Fax |
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Provider Business Mailing Address
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Address Line | 3741 FOUR SPRINGS DR
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City | RESCUE
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State | CA
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Zip | 95672-9552
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Country | US
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Telephone | 916-337-5587
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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 | 2251P0200X
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Taxonomy Name | Pediatric Physical Therapist
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License Number | 25931
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License Number State | CA
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