Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT40730 | CA |
NPI | 1003247644 |
---|---|
Provider Name | Sharen N Cheathon |
First Address | San Luis Obispo, CA 93401-2416 |
Second Address | Lodi, CA 95242-2182 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2013 |
Last Update Date | 09/12/2013 |