Basic Information
| Provider Information | |||||||||
| NPI: | 1215993753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HALL | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SHIMETA | ||||||||
| OtherFirstName: | CHERYL | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | W239N1812 ROCKWOOD DR | ||||||||
| Address2: | SUITE 100, PHCMA INC | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625230310 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | W239N1812 ROCKWOOD DR | ||||||||
| Address2: | SUITE 100, PHCMA INC. | ||||||||
| City: | WAUKESHA | ||||||||
| State: | WI | ||||||||
| PostalCode: | 531881113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2625230310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 01/19/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 10227 | WI | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 40430700 | 05 | WI | MEDICAID |