Basic Information
Provider Information
NPI: 1558478222
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PFRUENDER
FirstName: CHERYL
MiddleName: C
NamePrefix:  
NameSuffix:  
Credential: PT, DPT, MTC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: CANUPP
OtherFirstName: CHERYL
OtherMiddleName: E
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential: PT, DPT, MTC
OtherLastNameType: 1
Mailing Information
Address1: 1910 N CHURCH ST
Address2: SUITE D
City: GREENSBORO
State: NC
PostalCode: 274055632
CountryCode: US
TelephoneNumber: 3362747480
FaxNumber: 3362748903
Practice Location
Address1: 2828 MAPLEWOOD AVE
Address2: SUITE A
City: WINSTON SALEM
State: NC
PostalCode: 271034138
CountryCode: US
TelephoneNumber: 3367654703
FaxNumber: 3367654703
Other Information
ProviderEnumerationDate: 08/25/2006
LastUpdateDate: 11/23/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000X10100NCY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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