Provider Demographics
NPI:1134846496
Name:GAUVIN, CHEYENNE JESSICA (MPT)
Entity type:Individual
Prefix:MS
First Name:CHEYENNE
Middle Name:JESSICA
Last Name:GAUVIN
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 CRESCENT ST APT 1B
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-3856
Mailing Address - Country:US
Mailing Address - Phone:347-616-1304
Mailing Address - Fax:
Practice Address - Street 1:233 BROADWAY RM 1410
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10279-1814
Practice Address - Country:US
Practice Address - Phone:212-233-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049228225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist