Provider Demographics
NPI:1528351947
Name:ROWE, CHERYL LYNN (C M T)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:ROWE
Suffix:
Gender:F
Credentials:C M T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2259 ROCKWOOD AVE
Mailing Address - Street 2:APT. 202
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-3194
Mailing Address - Country:US
Mailing Address - Phone:612-655-7059
Mailing Address - Fax:
Practice Address - Street 1:1313 5TH ST SE
Practice Address - Street 2:224-B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55414-4504
Practice Address - Country:US
Practice Address - Phone:612-655-7059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist