Provider Demographics
NPI:1275007924
Name:CORE, CHEYENNE (DPT)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:CORE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:
Other - Last Name:BARTLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:420 TEE CT
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-5702
Mailing Address - Country:US
Mailing Address - Phone:805-709-6419
Mailing Address - Fax:
Practice Address - Street 1:117 S HALCYON RD
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-3115
Practice Address - Country:US
Practice Address - Phone:805-481-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist