MEDICARE: JENNIFER CHEETHAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	12269	LA

General Provider Information

NPI Number	:	1871440966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER CHEETHAM

Provider Business Mailing Address
First Line	:	1041 CHINABERRY DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2438
Country	:	US
Telephone Number	:	318-746-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1041 CHINABERRY DR
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-2438
Country	:	US
Telephone Number	:	318-746-1199
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ JENNIFER CHEETHAM ” Practice Location

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