MEDICARE: TRACEY LEE CHERRY 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	174400000X	Specialist	PT35799	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306948005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACEY LEE CHERRY PT

Provider Business Mailing Address
First Line	:	1418 GLENDALE AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8011
Country	:	US
Telephone Number	:	214-548-0811
Fax Number	:	214-548-0811

Provider Business Practice Location Address
First Line	:	1418 GLENDALE AVE NW
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-8011
Country	:	US
Telephone Number	:	214-548-0811
Fax Number	:	214-548-0811

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

Provider Enumeration Date	:	09/02/2006
Last Update Date	:	12/08/2025

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