Provider Demographics
NPI:1427145697
Name:ROOT, CHERRYL E (RPT)
Entity type:Individual
Prefix:
First Name:CHERRYL
Middle Name:E
Last Name:ROOT
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2610 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3182
Mailing Address - Country:US
Mailing Address - Phone:417-659-9948
Mailing Address - Fax:417-659-8800
Practice Address - Street 1:2610 OZARK AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3182
Practice Address - Country:US
Practice Address - Phone:417-659-9948
Practice Address - Fax:417-659-8800
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038207225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist