Provider Demographics
NPI:1619544798
Name:SALLEE, CHEYENNE BROOKE (PTA)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:BROOKE
Last Name:SALLEE
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 1:1730 VZ COUNTY ROAD 4511
Mailing Address - Street 2:
Mailing Address - City:BEN WHEELER
Mailing Address - State:TX
Mailing Address - Zip Code:75754-3338
Mailing Address - Country:US
Mailing Address - Phone:903-360-3551
Mailing Address - Fax:
Practice Address - Street 1:2808 S MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:LINDALE
Practice Address - State:TX
Practice Address - Zip Code:75771-7854
Practice Address - Country:US
Practice Address - Phone:903-780-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4060563225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant