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NPI Code Detail

MEDICARE: CHERYL JOAN DETTEN P.T.

MEDICARE: CHERYL JOAN DETTEN P.T.
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
12251P0200XPediatric Physical Therapist1143097TX
2225100000XPhysical Therapist1143097TX

General Provider Information

NPI Number : 1750466736
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHERYL JOAN DETTEN P.T.
Provider Business Mailing Address
First Line : 12871 WESTHORPE DR
Second Line :
City : HOUSTON
State : TX
Zip : 77077-3736
Country : US
Telephone Number : 713-504-3442
Fax Number :
Provider Business Practice Location Address
First Line : 1431 GREENWAY DR STE 500
Second Line :
City : IRVING
State : TX
Zip : 75038-2444
Country : US
Telephone Number : 713-783-8181
Fax Number : 832-781-2001
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/26/2006
Last Update Date : 12/06/2024

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