Provider Demographics
NPI:1275319923
Name:HOUGHTBY, CHEYENNE RENAE (ANMT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:RENAE
Last Name:HOUGHTBY
Suffix:
Gender:F
Credentials:ANMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1314 OLIVE AVE
Mailing Address - Street 2:
Mailing Address - City:REDDIND
Mailing Address - State:CA
Mailing Address - Zip Code:96000
Mailing Address - Country:US
Mailing Address - Phone:530-200-0982
Mailing Address - Fax:
Practice Address - Street 1:1465 VICTOR AVE STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4856
Practice Address - Country:US
Practice Address - Phone:530-200-0982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85021225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist