Provider Demographics
NPI:1508106436
Name:SURVOY, CELESTE ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:CELESTE
Middle Name:ANN
Last Name:SURVOY
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 1:795 VICTORIA CIR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-3229
Mailing Address - Country:US
Mailing Address - Phone:330-722-3464
Mailing Address - Fax:
Practice Address - Street 1:795 VICTORIA CIR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-3229
Practice Address - Country:US
Practice Address - Phone:330-722-3464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH08086172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker