Cheryl Tirtowidjojo

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

110 Rosewood St
Lake Jackson, TX 77566-4937

Phone

(979) 665-5953

NPI assigned

Jan 11, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610323200000",
    "number": "1346839719",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ROSEWOOD ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775664937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ROSEWOOD ST",
            "city": "LAKE JACKSON",
            "state": "TX",
            "postal_code": "775664937",
            "telephone_number": "979-665-5953"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIRTOWIDJOJO",
        "first_name": "CHERYL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-01-11",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Neethu Thomas
• Crystal Nichole Thomason, M.ED. CCC-SLP
• Thompson Orthopedic Clinic, PA
• Krysta Danae Thompson, DNP, APRN, FNP-C
• Sanford R Thompson Jr., M.D.
• TLC Family Clinic PLLC
• Andrea Nicole Todd, FNP-C
• Dana Dianne Tolbert, P.T
• Total Neurology of the Gulf Coast, PA
• Kary Tracy, OT

• Athletic Trainer in Lake Jackson, TX
• Providers in Lake Jackson, TX by specialty
• Athletic Trainer in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.