Individual
CHEYENNE CORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
117 S HALCYON RD, ARROYO GRANDE, CA 93420-3115
(805) 481-5656
Mailing address
420 TEE CT, NIPOMO, CA 93444-5702
(805) 709-6419
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
296044
CA
Other
Enumeration date
01/16/2019
Last updated
05/12/2024
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