Provider Demographics
NPI:1003567389
Name:PEJI, CEDRIC (PT)
Entity Type:Individual
Prefix:
First Name:CEDRIC
Middle Name:
Last Name:PEJI
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:SACHSE
Mailing Address - State:TX
Mailing Address - Zip Code:75048-4363
Mailing Address - Country:US
Mailing Address - Phone:469-931-9530
Mailing Address - Fax:
Practice Address - Street 1:1650 REPUBLIC PKWY STE 103
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6926
Practice Address - Country:US
Practice Address - Phone:972-698-1145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-18
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1355762225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist