Provider Demographics
NPI:1801021381
Name:BAIN, CECILIA (PT, DPT)
Entity Type:Individual
Prefix:
First Name:CECILIA
Middle Name:
Last Name:BAIN
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1377 OSCEOLA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1430
Mailing Address - Country:US
Mailing Address - Phone:215-760-5604
Mailing Address - Fax:
Practice Address - Street 1:4231 W 16TH AVE
Practice Address - Street 2:GROUND FLOOR PHYSICAL REHAB DEPT
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1335
Practice Address - Country:US
Practice Address - Phone:303-629-4624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9317225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist