Provider Demographics
NPI:1487329587
Name:SPURGIN, CHEYENNE (PTA)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:SPURGIN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 HIGHWAY D
Mailing Address - Street 2:
Mailing Address - City:FRENCH VILLAGE
Mailing Address - State:MO
Mailing Address - Zip Code:63036-1103
Mailing Address - Country:US
Mailing Address - Phone:573-330-6921
Mailing Address - Fax:
Practice Address - Street 1:10 LAKE DR
Practice Address - Street 2:
Practice Address - City:BONNE TERRE
Practice Address - State:MO
Practice Address - Zip Code:63628-1820
Practice Address - Country:US
Practice Address - Phone:573-359-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015024282225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant