Provider Demographics
NPI:1962763482
Name:IMPERATORE, CHERYL ANN (LMT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:IMPERATORE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14411 CHRISMAN HILL DR
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-9038
Mailing Address - Country:US
Mailing Address - Phone:301-802-0830
Mailing Address - Fax:
Practice Address - Street 1:14411 CHRISMAN HILL DR
Practice Address - Street 2:
Practice Address - City:BOYDS
Practice Address - State:MD
Practice Address - Zip Code:20841-9038
Practice Address - Country:US
Practice Address - Phone:301-802-0830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM02818225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDM02818OtherLICENSED MASSAGE THERAPIST, DEPT OF HEALTH AND MENTAL HYGIENE