Provider Demographics
NPI:1821142712
Name:MCDERMOTT, CELIA (LPTA, LMT, CNMT)
Entity Type:Individual
Prefix:
First Name:CELIA
Middle Name:
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:LPTA, LMT, CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 DAYRON CT
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-1798
Mailing Address - Country:US
Mailing Address - Phone:770-653-1358
Mailing Address - Fax:
Practice Address - Street 1:1905 WOODSTOCK RD
Practice Address - Street 2:SUITE 3100
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-5616
Practice Address - Country:US
Practice Address - Phone:770-653-1358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA001371225200000X
GAMT000165225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist