Provider Demographics
NPI:1417365388
Name:AUGUSTA, CECILLE CANIMO (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:CECILLE
Middle Name:CANIMO
Last Name:AUGUSTA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SUGAR MAPLE LN
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-2716
Mailing Address - Country:US
Mailing Address - Phone:201-240-4292
Mailing Address - Fax:
Practice Address - Street 1:732 NEWMAN SPRINGS RD
Practice Address - Street 2:SUITE 300
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1541
Practice Address - Country:US
Practice Address - Phone:732-747-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA008582002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics