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General NPI Number Information
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NPI Number | 1487329587
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Entity Type | Individual
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Provider Name | CHEYENNE SPURGIN PTA
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Gender | Female
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Dates
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Enumeration Date | 08/11/2021
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 10 LAKE DR
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City | BONNE TERRE
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State | MO
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Zip | 63628-1820
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Country | US
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Telephone | 573-359-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 9340 HIGHWAY D
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City | FRENCH VILLAGE
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State | MO
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Zip | 63036-1103
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Country | US
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Telephone | 573-330-6921
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 2015024282
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License Number State | MO
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