Individual
MRS. CHERYL ELIZABETH WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4211 U.S. HIGHWAY 1 SOUTH, SAINT AUGUSTINE, FL 32086-7096
(904) 794-0854
Mailing address
4211 U.S. HIGHWAY 1 SOUTH, SAINT AUGUSTINE, FL 32086-7096
(904) 794-0854
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA35162
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C1650
BLUECROSS BLUESHIELD
FL
Enumeration date
11/29/2007
Last updated
03/31/2010
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