MEDICARE: AMANDA JO CHEROK PT, DPT

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	PHYP2590	AK

General Provider Information

NPI Number	:	1083900112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JO CHEROK PT, DPT

Provider Business Mailing Address
First Line	:	PO BOX 933
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-0933
Country	:	US
Telephone Number	:	814-242-0110
Fax Number	:

Provider Business Practice Location Address
First Line	:	601 E PIONEER AVE STE 218
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7694
Country	:	US
Telephone Number	:	907-235-7473
Fax Number	:	907-205-5370

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

Provider Enumeration Date	:	06/27/2011
Last Update Date	:	04/17/2018

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