Provider Demographics
NPI:1891276663
Name:POWER, CHEYENNE (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:POWER
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:M
Other - Last Name:HERTLEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:407 DELOACH RD NE
Mailing Address - Street 2:
Mailing Address - City:LUDOWICI
Mailing Address - State:GA
Mailing Address - Zip Code:31316-3251
Mailing Address - Country:US
Mailing Address - Phone:207-745-9156
Mailing Address - Fax:
Practice Address - Street 1:1061 HARMON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-5641
Practice Address - Country:US
Practice Address - Phone:912-435-6780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-28
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPT4647225100000X
GAPT013919225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist