Provider Demographics
NPI:1326243932
Name:CEDENO, ROBERTO R (PHYSICAL THERAPY ASS)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:R
Last Name:CEDENO
Suffix:
Gender:M
Credentials:PHYSICAL THERAPY ASS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23777 MAUDE LEA ST
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3540
Mailing Address - Country:US
Mailing Address - Phone:248-504-7126
Mailing Address - Fax:
Practice Address - Street 1:23777 MAUDE LEA ST
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3540
Practice Address - Country:US
Practice Address - Phone:248-504-7126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant