Provider Demographics
NPI:1245595032
Name:CELINO, MAILA HIZOLA (PT)
Entity Type:Individual
Prefix:MISS
First Name:MAILA
Middle Name:HIZOLA
Last Name:CELINO
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 1:4132 FAIRLAKE LN APT A
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2709
Mailing Address - Country:US
Mailing Address - Phone:407-620-0933
Mailing Address - Fax:
Practice Address - Street 1:4132 FAIRLAKE LN APT A
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2709
Practice Address - Country:US
Practice Address - Phone:407-620-0933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-09
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0002781225100000X
VA2305207802225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist