Provider Demographics
NPI:1386747921
Name:PHILLIPS, CHERI DIAN (PHYSICAL THERAPIST)
Entity type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:DIAN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:CHERI
Other - Middle Name:DIAN
Other - Last Name:SHORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6977 PROFESSIONAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240
Mailing Address - Country:US
Mailing Address - Phone:941-758-3140
Mailing Address - Fax:941-870-4891
Practice Address - Street 1:6977 PROFESSIONAL PKWY E
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240
Practice Address - Country:US
Practice Address - Phone:941-758-3140
Practice Address - Fax:941-870-4891
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070009626225100000X
FLPT25447225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist