Provider Demographics
NPI:1750792453
Name:COCKRILL, CHEYENNE RACHEL (PTA)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:RACHEL
Last Name:COCKRILL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CHEYENNE
Other - Middle Name:RACHEL
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:1200 CORPORATE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35242-5424
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:
Practice Address - Street 1:14802 SHAMROCK WAY STE C
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:MO
Practice Address - Zip Code:64089-8381
Practice Address - Country:US
Practice Address - Phone:816-873-1101
Practice Address - Fax:816-399-5796
Is Sole Proprietor?:No
Enumeration Date:2014-05-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013038815225200000X
OK2411225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant