Provider Demographics
NPI:1598421760
Name:CHEATHAMS, BAILEE (PTA)
Entity Type:Individual
Prefix:MRS
First Name:BAILEE
Middle Name:
Last Name:CHEATHAMS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MS
Other - First Name:BAILEE
Other - Middle Name:
Other - Last Name:NEWTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:PO BOX 10083
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46850-0083
Mailing Address - Country:US
Mailing Address - Phone:260-431-8198
Mailing Address - Fax:260-755-0475
Practice Address - Street 1:3110 MALLARD COVE LN
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2882
Practice Address - Country:US
Practice Address - Phone:260-431-8198
Practice Address - Fax:260-755-0475
Is Sole Proprietor?:No
Enumeration Date:2021-11-12
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06006233A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant