Provider Demographics
NPI:1699109801
Name:MCILRAITH, P. CHERYL
Entity type:Individual
Prefix:
First Name:P. CHERYL
Middle Name:
Last Name:MCILRAITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:P. CHERYL
Other - Middle Name:
Other - Last Name:MCILRAITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MT
Mailing Address - Street 1:10101 W PARMER LN
Mailing Address - Street 2:1617
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-5000
Mailing Address - Country:US
Mailing Address - Phone:858-220-4090
Mailing Address - Fax:
Practice Address - Street 1:10101 W PARMER LN
Practice Address - Street 2:1617
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-5000
Practice Address - Country:US
Practice Address - Phone:858-220-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100738225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist