Basic Information
| Provider Information | |||||||||
| NPI: | 1093831653 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURR | ||||||||
| FirstName: | CHERYL | ||||||||
| MiddleName: | DENISE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2110 FOX DRIVE | ||||||||
| Address2: | SUITE B | ||||||||
| City: | CHAMPAIGN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173551616 | ||||||||
| FaxNumber: | 2173552620 | ||||||||
| Practice Location | |||||||||
| Address1: | 220 FORT JESSE ROAD | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | NORMAL | ||||||||
| State: | IL | ||||||||
| PostalCode: | 61761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3094541616 | ||||||||
| FaxNumber: | 3094545167 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 04/02/2009 | ||||||||
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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 | 070013049 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 070.013049 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 203 | 01 | IL | BLUE CROSS PROV ID | OTHER | 113326 | 01 | HEALTHLINK PROV ID | OTHER | 7216 | 01 | PERSONALCARE PROV ID | OTHER | 4117 | 01 | IL | HAMP PROVIDER ID | OTHER |