Provider Demographics
NPI:1275007924
Name:BARTLETT, CHEYENNE (DPT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25200 CARLOS BEE BLVD APT 560
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94542-1547
Mailing Address - Country:US
Mailing Address - Phone:805-709-6419
Mailing Address - Fax:
Practice Address - Street 1:301 LENNON LN STE 202
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2433
Practice Address - Country:US
Practice Address - Phone:925-934-6373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA296044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist