MEDICARE: MRS. CHEYENNE K ALLEN PT

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12219	OTHER	TN	PT LICENSE

General Provider Information

NPI Number	:	1932666039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHEYENNE K ALLEN PT

Provider Business Mailing Address
First Line	:	140 SAVANNAH LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5207
Country	:	US
Telephone Number	:	423-494-4302
Fax Number	:	678-567-6737

Provider Business Practice Location Address
First Line	:	140 SAVANNAH LN
Second Line	:
City	:	ROCKY TOP
State	:	TN
Zip	:	37769-5207
Country	:	US
Telephone Number	:	423-494-4302
Fax Number	:	678-567-6737

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

Provider Enumeration Date	:	02/25/2019
Last Update Date	:	08/14/2023

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