Provider Demographics
NPI:1619051315
Name:CHESHIRE, VINCENT E (PT)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:E
Last Name:CHESHIRE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1702 HIGHWAY 11 N
Mailing Address - Street 2:SUITE B
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-2016
Mailing Address - Country:US
Mailing Address - Phone:601-749-2227
Mailing Address - Fax:601-749-2241
Practice Address - Street 1:1702 HIGHWAY 11 N
Practice Address - Street 2:SUITE B
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-2016
Practice Address - Country:US
Practice Address - Phone:601-749-2227
Practice Address - Fax:601-749-2241
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT13962251X0800X
LAPT 11322251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4B469C952Medicare ID - Type UnspecifiedLOUISIANA MEDICARE