Provider Demographics
NPI:1518409747
Name:ACEVEDO, MARIA CECILIA (PT)
Entity Type:Individual
Prefix:
First Name:MARIA CECILIA
Middle Name:
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARIA CECILIA
Other - Middle Name:VALENCIA
Other - Last Name:PALAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12544 DILLINGHAM SQ
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-5259
Mailing Address - Country:US
Mailing Address - Phone:703-730-6969
Mailing Address - Fax:
Practice Address - Street 1:12544 DILLINGHAM SQ
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-5259
Practice Address - Country:US
Practice Address - Phone:703-730-6969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305210771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist