Provider Demographics
NPI:1760229629
Name:CHERRY PHYSICAL THERAPY, INC.
Entity type:Organization
Organization Name:CHERRY PHYSICAL THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:214-548-0811
Mailing Address - Street 1:1418 GLENDALE AVE NW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-8011
Mailing Address - Country:US
Mailing Address - Phone:214-548-0811
Mailing Address - Fax:
Practice Address - Street 1:571 HAVERTY CT STE W
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-3614
Practice Address - Country:US
Practice Address - Phone:214-548-0811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy