Provider Demographics
NPI:1285763854
Name:BRONNER, CHERYL VICTORIA (PHD, PT, OCS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:VICTORIA
Last Name:BRONNER
Suffix:
Gender:F
Credentials:PHD, PT, OCS
Other - Prefix:DR
Other - First Name:SHAW
Other - Middle Name:
Other - Last Name:BRONNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, PT, OCS
Mailing Address - Street 1:90 8TH AVE
Mailing Address - Street 2:#11B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1553
Mailing Address - Country:US
Mailing Address - Phone:718-246-6377
Mailing Address - Fax:718-246-6383
Practice Address - Street 1:122 ASHLAND PL
Practice Address - Street 2:#1A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3973
Practice Address - Country:US
Practice Address - Phone:718-246-6377
Practice Address - Fax:718-246-6383
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008223-12251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports