Provider Demographics
NPI:1124861059
Name:THE CHEER DOCTOR
Entity type:Organization
Organization Name:THE CHEER DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WISMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-678-0135
Mailing Address - Street 1:7361 FRASIER RD
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8173
Mailing Address - Country:US
Mailing Address - Phone:614-678-0135
Mailing Address - Fax:
Practice Address - Street 1:205 INTEK WAY STE 300
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-9041
Practice Address - Country:US
Practice Address - Phone:614-678-0135
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy