Provider Demographics
NPI:1215993753
Name:HALL, CHERYL (PT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:SHIMETA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:W239N1812 ROCKWOOD DR
Mailing Address - Street 2:SUITE 100, PHCMA INC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1113
Mailing Address - Country:US
Mailing Address - Phone:262-523-0310
Mailing Address - Fax:
Practice Address - Street 1:W239N1812 ROCKWOOD DR
Practice Address - Street 2:SUITE 100, PHCMA INC.
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1113
Practice Address - Country:US
Practice Address - Phone:262-523-0310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10227225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40430700Medicaid
WI40430700Medicaid
WI81030Medicare PIN
WIQ11613Medicare UPIN