Provider Demographics
NPI:1508469776
Name:CEPEDA, JAILYN (DPT)
Entity Type:Individual
Prefix:
First Name:JAILYN
Middle Name:
Last Name:CEPEDA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 ARLINGTON AVE APT 2T
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-1304
Mailing Address - Country:US
Mailing Address - Phone:845-754-3135
Mailing Address - Fax:
Practice Address - Street 1:1 BRIDGE ST STE 71
Practice Address - Street 2:
Practice Address - City:IRVINGTON
Practice Address - State:NY
Practice Address - Zip Code:10533-1560
Practice Address - Country:US
Practice Address - Phone:914-478-0608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-19
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046566225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist