Provider Demographics
NPI:1629363080
Name:CERRETO, MICHAEL (MS, CSC, LDR, EDU-K)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:CERRETO
Suffix:
Gender:M
Credentials:MS, CSC, LDR, EDU-K
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 CASTLE HILL RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-1150
Mailing Address - Country:US
Mailing Address - Phone:804-272-3927
Mailing Address - Fax:
Practice Address - Street 1:1700 HUGUENOT RD
Practice Address - Street 2:SUITE D
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2397
Practice Address - Country:US
Practice Address - Phone:804-272-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner