Provider Demographics
NPI:1043231822
Name:CEELY, CRISTINE A (DPT, GCS)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINE
Middle Name:A
Last Name:CEELY
Suffix:
Gender:F
Credentials:DPT, GCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17817 CADDY DR
Mailing Address - Street 2:
Mailing Address - City:DERWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20855-1005
Mailing Address - Country:US
Mailing Address - Phone:301-963-8126
Mailing Address - Fax:
Practice Address - Street 1:6308 DEMOCRACY BLVD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1664
Practice Address - Country:US
Practice Address - Phone:301-530-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18489225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist