Healthcare Provider Details

I. General information

NPI: 1659024750
Provider Name (Legal Business Name): NATALIE GABRIELLE CHESHIRE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2022
Last Update Date: 05/20/2025
Certification Date: 05/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 N WICKHAM RD
MELBOURNE FL
32940-7304
US

IV. Provider business mailing address

5565 N WICKHAM RD
MELBOURNE FL
32940-7304
US

V. Phone/Fax

Practice location:
  • Phone: 407-573-3352
  • Fax: 407-573-3355
Mailing address:
  • Phone: 407-573-3352
  • Fax: 407-573-3355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT29240
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT29240
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: