1770684052 NPI number — CHEESMAN HEALTHCARE, P.C.

Table of content: HALEY ASHTON PT, DPT (NPI 1467083170)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770684052 NPI number — CHEESMAN HEALTHCARE, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEESMAN HEALTHCARE, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770684052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 W COUNTY ROAD 100 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46122-8205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-272-7950
Provider Business Mailing Address Fax Number:
317-272-7963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
97 DOVER ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
AVON
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46123-7380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-272-7950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEESMAN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
ALAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
317-272-7950

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01054637A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1093766826 . This is a "NPI NUMBER" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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