Provider Demographics
NPI:1154576767
Name:THOMAS, CHERYL FAUBION (PT, DPT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:FAUBION
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:FAUBION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:2519 SOUTH LAKELINE BLVD, SUITE 100
Mailing Address - Street 2:TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER,INC
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-2964
Mailing Address - Country:US
Mailing Address - Phone:512-331-6200
Mailing Address - Fax:
Practice Address - Street 1:2519 SOUTH LAKELINE BLVD, SUITE 100
Practice Address - Street 2:TILLMAN PHYSICAL THERAPY & SPORTS TRAINING CENTER,INC
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-2964
Practice Address - Country:US
Practice Address - Phone:512-331-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-24
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1184763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1184763OtherTEXAS BOARD OF PHYSICAL THERAPY