Provider Demographics
NPI:1528281052
Name:ROOT, CHERYL (LMP,CCST)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:ROOT
Suffix:
Gender:F
Credentials:LMP,CCST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1851
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98041-1851
Mailing Address - Country:US
Mailing Address - Phone:425-889-8722
Mailing Address - Fax:425-744-1128
Practice Address - Street 1:150 LAKE ST S
Practice Address - Street 2:SUITE 202
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-6460
Practice Address - Country:US
Practice Address - Phone:425-889-8722
Practice Address - Fax:425-744-1128
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00005159225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist