Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT1024 | MS |
N | 225100000X | Physical Therapist | PTH8602 | AL |
N | 2251E1200X | Ergonomics | PT4356 | AR |
N | 225XE1200X | Ergonomics | PT4356 | AR |
N | 2251G0304X | Physical Therapist - Geriatrics | 07743R | LA |
N | 2251X0800X | Physical Therapist - Orthopedic | PT21734 | FL |
NPI | 1316464316 |
---|---|
Provider Name | Dr. John Marty Cheeks |
First Address | Laurel, MS 39443-7346 |
Second Address | Collins, MS 39428-6293 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2017 |
Last Update Date | 24/09/2018 |