Provider Demographics
NPI:1659052322
Name:CEPPARO, KRISTIE (LMT)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:
Last Name:CEPPARO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:KRYSTAL
Other - Middle Name:
Other - Last Name:CEPPARO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2822 EDGEMONT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19134-4704
Mailing Address - Country:US
Mailing Address - Phone:516-939-3068
Mailing Address - Fax:
Practice Address - Street 1:2822 EDGEMONT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4704
Practice Address - Country:US
Practice Address - Phone:516-939-3068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG011816225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist