Provider Demographics
NPI:1497374524
Name:CERCIELLO, THERESA EILEEN (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:EILEEN
Last Name:CERCIELLO
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 WILSON RD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3523
Mailing Address - Country:US
Mailing Address - Phone:719-590-9681
Mailing Address - Fax:719-365-6791
Practice Address - Street 1:415 W ROCKRIMMON BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1776
Practice Address - Country:US
Practice Address - Phone:719-365-6871
Practice Address - Fax:719-365-6791
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO25712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic