Basic Information
| Provider Information | |||||||||
| NPI: | 1982169348 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HUFFMAN | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 PACIFIC AVE | ||||||||
| Address2: | |||||||||
| City: | WILLOWS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959882335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5305203919 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1133 W SYCAMORE ST | ||||||||
| Address2: | |||||||||
| City: | WILLOWS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959882601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5309341800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2019 | ||||||||
| LastUpdateDate: | 07/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT26223 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.