Individual provider Active NPI

Cherylann C Desdune-Mont, PT

  • Physical Therapist
  • Greenville, SC
National Provider Identifier
1609980838
Registry record updated Nov 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5316 Issued in SC
Practice address
200 Patewood Dr
Ste C250
Greenville, SC 29615-3593
Phone
(864) 454-0952
NPI assigned
Aug 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5316 SC Primary

Addresses

Primary practice location

200 Patewood Dr
Ste C250
Greenville, SC 29615-3593

Mailing address

103 N Main St
Ste 300
Greenville, SC 29601-2796
Phone (864) 528-5700

Other identifiers 1

IdentifierTypeStateIssuer
TH1727MedicaidSC

Other names 1

  • Cherylann C Desdune Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5316SCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Prisma Health University Medical Group Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353456000000",
    "number": "1609980838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "103 N MAIN ST",
            "address_2": "STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012796",
            "telephone_number": "864-528-5700",
            "fax_number": "864-528-5701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 PATEWOOD DR",
            "address_2": "STE C250",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296153593",
            "telephone_number": "864-454-0952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DESDUNE-MONT",
        "first_name": "CHERYLANN",
        "middle_name": "C",
        "credential": "PT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-17",
        "last_updated": "2012-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "SC",
            "license": "5316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TH1727",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHERYLANN",
            "last_name": "DESDUNE",
            "middle_name": "C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; 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.