Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 070.007251 | IL |
NPI | 1043583065 |
---|---|
Provider Name | Mr. Charles W Cherry |
First Address | Geneva, IL 60134-4203 |
Second Address | Geneva, IL 60134-4203 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2012 |
Last Update Date | 22/02/2012 |