Provider Demographics
NPI:1073862546
Name:DALZELL, CECILIA JOAN (PT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:JOAN
Last Name:DALZELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:CECILIA
Other - Middle Name:JOAN
Other - Last Name:REIMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7407 N DIVISION STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-5689
Mailing Address - Country:US
Mailing Address - Phone:509-474-9197
Mailing Address - Fax:509-443-3834
Practice Address - Street 1:7407 N DIVISION STREET
Practice Address - Street 2:SUITE C
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-5689
Practice Address - Country:US
Practice Address - Phone:509-474-9197
Practice Address - Fax:509-443-3834
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005774225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8937486Medicare PIN
WAG8914232Medicare PIN