Provider Demographics
NPI:1760890875
Name:REX, CECELIA (LMT)
Entity Type:Individual
Prefix:MS
First Name:CECELIA
Middle Name:
Last Name:REX
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:PO BOX 22307
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-2307
Mailing Address - Country:US
Mailing Address - Phone:267-595-5658
Mailing Address - Fax:
Practice Address - Street 1:520 N DELAWARE AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-4226
Practice Address - Country:US
Practice Address - Phone:267-595-5658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG 006078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist