Provider Demographics
NPI:1760940787
Name:PETERS, CHEYENNE MARIE (PT, DPT,SCS,LAT, ATC)
Entity type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:MARIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PT, DPT,SCS,LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 S WADSWORTH BLVD STE A-2
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5026
Mailing Address - Country:US
Mailing Address - Phone:303-993-4438
Mailing Address - Fax:303-993-4817
Practice Address - Street 1:3255 S WADSWORTH BLVD STE A-2
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5026
Practice Address - Country:US
Practice Address - Phone:303-993-4438
Practice Address - Fax:303-993-4817
Is Sole Proprietor?:No
Enumeration Date:2019-03-08
Last Update Date:2025-11-15
Deactivation Date:2022-01-04
Deactivation Code:
Reactivation Date:2022-06-16
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018336225100000X
CO183362251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist