Provider Demographics
NPI:1164528733
Name:CELESTINO, JOHN R (PT, GCS MTC CSCS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:CELESTINO
Suffix:
Gender:M
Credentials:PT, GCS MTC CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 S STEEN RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8775
Mailing Address - Country:US
Mailing Address - Phone:509-922-8081
Mailing Address - Fax:
Practice Address - Street 1:2521 S STEEN RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99016-8775
Practice Address - Country:US
Practice Address - Phone:509-922-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT2535225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACE6440OtherASURIS HEALTH PLANS
WA22823OtherDEPT OF L&I
WA8335093Medicaid
WACE6440OtherUNITED NW SERVICES
WA5524696OtherAETNA INSURANCE
WA22823OtherDEPT OF L&I
WA5524696OtherAETNA INSURANCE