Provider Demographics
NPI:1295190858
Name:CEGIELSKI, HEATHER LYNN (LMT,MMP)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:LYNN
Last Name:CEGIELSKI
Suffix:
Gender:F
Credentials:LMT,MMP
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:DEIBLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMT, MMP
Mailing Address - Street 1:2022 E ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-6045
Mailing Address - Country:US
Mailing Address - Phone:407-900-5937
Mailing Address - Fax:
Practice Address - Street 1:2022 E ROBINSON ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6045
Practice Address - Country:US
Practice Address - Phone:407-900-5937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA78414225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMA78414OtherLMT MA78414