Provider Demographics
NPI:1588902506
Name:SHAEFFER, CHERYL ANN (PT, DPT, MTC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:SHAEFFER
Suffix:
Gender:F
Credentials:PT, DPT, MTC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:COLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 BEECHWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-6711
Mailing Address - Country:US
Mailing Address - Phone:305-431-2988
Mailing Address - Fax:
Practice Address - Street 1:115 BEECHWOOD RD
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-6711
Practice Address - Country:US
Practice Address - Phone:305-431-2988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15238225100000X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic