MEDICARE: CHERYL LEE FLETCHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	1160	OR

General Provider Information

NPI Number	:	1033453204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LEE FLETCHER

Provider Business Mailing Address
First Line	:	1006 WATERCREST RD
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1154
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1006 WATERCREST RD
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-1154
Country	:	US
Telephone Number	:	971-732-9436
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	11/12/2012

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Directions to “ CHERYL LEE FLETCHER ” Practice Location

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