Provider Demographics
NPI:1700616471
Name:CHERESTAL, CATHREVENY
Entity type:Individual
Prefix:
First Name:CATHREVENY
Middle Name:
Last Name:CHERESTAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6728 HIGHLAND HOUSE CT APT A
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63123-2525
Mailing Address - Country:US
Mailing Address - Phone:863-393-2417
Mailing Address - Fax:
Practice Address - Street 1:1552 COUNTRY CLUB DR PLAZA
Practice Address - Street 2:UNIT 1570
Practice Address - City:ST. CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303
Practice Address - Country:US
Practice Address - Phone:636-724-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant