Provider Demographics
NPI:1841526928
Name:EVIDENTE, CHERRY DELL REVILLA (PT)
Entity type:Individual
Prefix:MRS
First Name:CHERRY DELL
Middle Name:REVILLA
Last Name:EVIDENTE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CHERRY DELL
Other - Middle Name:DERECHO
Other - Last Name:REVILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1925 W TURNER ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-5513
Mailing Address - Country:US
Mailing Address - Phone:610-794-5260
Mailing Address - Fax:
Practice Address - Street 1:1925 W TURNER ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-5513
Practice Address - Country:US
Practice Address - Phone:610-794-5312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-26
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028088225100000X
PA018261225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist