MEDICARE: CHERYL DOTY PT

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	PT10979	FL

General Provider Information

NPI Number	:	1063446003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL DOTY PT

Provider Business Mailing Address
First Line	:	5029 CIMARRON DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-2552
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 E BROADWAY ST
Second Line	:
City	:	FORT MEADE
State	:	FL
Zip	:	33841-2904
Country	:	US
Telephone Number	:	683-534-9544
Fax Number	:

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

Provider Enumeration Date	:	07/10/2006
Last Update Date	:	07/08/2007

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