Provider Demographics
NPI:1639659634
Name:SUMODOBILA, CELIA HOLGADO
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:HOLGADO
Last Name:SUMODOBILA
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 1:28219 NANCY LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77385-9041
Mailing Address - Country:US
Mailing Address - Phone:936-718-9537
Mailing Address - Fax:
Practice Address - Street 1:28219 NANCY LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77385-9041
Practice Address - Country:US
Practice Address - Phone:936-718-9537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-19
Last Update Date:2018-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist