Individual
CHEYENNE FACKLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10969 SE 175TH PL, SUMMERFIELD, FL 34491-0902
(352) 347-8877
Mailing address
8477 S SUNCOAST BLVD, HOMOSASSA, FL 34446-5028
(352) 382-1141
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA29059
FL
Other
Enumeration date
02/11/2019
Last updated
02/11/2019
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