Provider Demographics
NPI:1528399649
Name:BEARDEN, CELESTA
Entity Type:Individual
Prefix:
First Name:CELESTA
Middle Name:
Last Name:BEARDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 S QUEBEC ST STE A6
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-3194
Mailing Address - Country:US
Mailing Address - Phone:303-770-6440
Mailing Address - Fax:303-770-6439
Practice Address - Street 1:8200 S QUEBEC ST STE A6
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-3194
Practice Address - Country:US
Practice Address - Phone:303-770-6440
Practice Address - Fax:303-770-6439
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5963225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist