Provider Demographics
NPI:1538111711
Name:CHEEK, CAROLINE ZACHARIAS (MSPT)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ZACHARIAS
Last Name:CHEEK
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SE MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29681-2651
Mailing Address - Country:US
Mailing Address - Phone:864-967-3082
Mailing Address - Fax:864-967-3083
Practice Address - Street 1:415 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-2651
Practice Address - Country:US
Practice Address - Phone:864-967-3082
Practice Address - Fax:864-967-3083
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5029225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTH1605Medicaid