Provider Demographics
NPI:1194743518
Name:ERTELT, CHERYL A (PT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:ERTELT
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:1228 GLENWOOD AVE
Mailing Address - Street 2:FORT WAYNE
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46805-2648
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11119 PARKVIEW PLAZA DR
Practice Address - Street 2:FORT WAYNE
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1705
Practice Address - Country:US
Practice Address - Phone:260-482-7811
Practice Address - Fax:260-482-7712
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN05001695225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist