Provider Demographics
NPI:1073051181
Name:CELESTE, THEODORE JAVELOSA (BCTMB)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JAVELOSA
Last Name:CELESTE
Suffix:
Gender:M
Credentials:BCTMB
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2264
Mailing Address - Country:US
Mailing Address - Phone:916-685-0818
Mailing Address - Fax:916-422-8068
Practice Address - Street 1:9727 ELK GROVE FLORIN RD
Practice Address - Street 2:SUITE 290
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2264
Practice Address - Country:US
Practice Address - Phone:916-685-0818
Practice Address - Fax:916-422-8068
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist