Provider Demographics
NPI:1073090668
Name:CEDERHOLM, MARY CAITLIN
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CAITLIN
Last Name:CEDERHOLM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 COX RD STE 301
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3320
Mailing Address - Country:US
Mailing Address - Phone:804-716-0457
Mailing Address - Fax:804-716-0496
Practice Address - Street 1:4101 COX RD STE 301
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3320
Practice Address - Country:US
Practice Address - Phone:804-716-0457
Practice Address - Fax:804-716-0496
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist