Provider Demographics
NPI:1497580161
Name:CHERUVIL, DAVID MATHEWS (PTA)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:MATHEWS
Last Name:CHERUVIL
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 BALDWIN DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48098-5624
Mailing Address - Country:US
Mailing Address - Phone:248-404-7538
Mailing Address - Fax:
Practice Address - Street 1:14151 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-5507
Practice Address - Country:US
Practice Address - Phone:586-939-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5502005016225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant