Provider Demographics
NPI:1538502737
Name:CEDENO, AME LETICIA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:AME
Middle Name:LETICIA
Last Name:CEDENO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24265 DIETZ DR
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-7002
Mailing Address - Country:US
Mailing Address - Phone:239-989-4879
Mailing Address - Fax:
Practice Address - Street 1:24850 OLD 41 RD
Practice Address - Street 2:UNIT 17
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-7021
Practice Address - Country:US
Practice Address - Phone:239-947-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA68374225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist