Provider Demographics
NPI:1285919027
Name:GIRARD, CHERYL LEE (LMP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LEE
Last Name:GIRARD
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 NEWPORT WAY NW
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5347
Mailing Address - Country:US
Mailing Address - Phone:425-269-6126
Mailing Address - Fax:
Practice Address - Street 1:2315 NEWPORT WAY NW
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5347
Practice Address - Country:US
Practice Address - Phone:425-269-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60249440172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist