Provider Demographics
NPI:1780837492
Name:CELSO, KRISTA MARLENE (OTR; PTA)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:MARLENE
Last Name:CELSO
Suffix:
Gender:F
Credentials:OTR; PTA
Other - Prefix:MISS
Other - First Name:KRISTA
Other - Middle Name:MARLENE
Other - Last Name:FRATANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:57 MILL ST
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NY
Mailing Address - Zip Code:14433-1412
Mailing Address - Country:US
Mailing Address - Phone:315-923-7761
Mailing Address - Fax:
Practice Address - Street 1:1335 PORTLAND AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14621-2706
Practice Address - Country:US
Practice Address - Phone:585-544-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-25
Last Update Date:2008-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY66 004176225200000X
NY63 012556225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant