Provider Demographics
NPI:1760940787
Name:PETERS, CHEYENNE MARIE (PT, DPT, LAT, ATC)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PT, DPT, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1637 HIGHWAY 85
Mailing Address - Street 2:
Mailing Address - City:MONTEZUMA
Mailing Address - State:IA
Mailing Address - Zip Code:50171-8590
Mailing Address - Country:US
Mailing Address - Phone:641-990-2602
Mailing Address - Fax:
Practice Address - Street 1:1262 BERGEN PKWY
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-9546
Practice Address - Country:US
Practice Address - Phone:303-674-7889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2022-06-16
Deactivation Date:2022-01-04
Deactivation Code:
Reactivation Date:2022-06-16
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018336225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist