Provider Demographics
NPI:1619583945
Name:CERLANEK, DEANNA MARIE (PT)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:CERLANEK
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 1:5849 E CIRCLE DR STE B
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:NY
Mailing Address - Zip Code:13039-8654
Mailing Address - Country:US
Mailing Address - Phone:315-635-5000
Mailing Address - Fax:
Practice Address - Street 1:15 E GENESEE ST STE 130
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-2544
Practice Address - Country:US
Practice Address - Phone:315-635-5000
Practice Address - Fax:315-635-3663
Is Sole Proprietor?:No
Enumeration Date:2020-09-22
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046322225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY046322OtherNY STATE LICENSE FROM OFFICE OF PROFESSIONS