Provider Demographics
NPI:1245243849
Name:CRATER, CECELIA RENEE (PT)
Entity Type:Individual
Prefix:
First Name:CECELIA
Middle Name:RENEE
Last Name:CRATER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TREASURE HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-2219
Mailing Address - Country:US
Mailing Address - Phone:501-223-8996
Mailing Address - Fax:501-801-0077
Practice Address - Street 1:1 TREASURE HILL RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-2219
Practice Address - Country:US
Practice Address - Phone:501-223-8996
Practice Address - Fax:501-801-0077
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT613225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR56128OtherAR BLUE CROSS BLUE SHIELD
AR120758721Medicaid
AR56128OtherAR BLUE CROSS BLUE SHIELD