Provider Demographics
NPI:1821325465
Name:PASCUAL, GLICELYN CEREZO
Entity Type:Individual
Prefix:
First Name:GLICELYN
Middle Name:CEREZO
Last Name:PASCUAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:B3 ERB ST
Mailing Address - Street 2:
Mailing Address - City:ORWIGSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17961
Mailing Address - Country:US
Mailing Address - Phone:570-581-6476
Mailing Address - Fax:570-628-4572
Practice Address - Street 1:1666 MOUNT HOPE AVE
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-1302
Practice Address - Country:US
Practice Address - Phone:570-622-2525
Practice Address - Fax:570-628-4572
Is Sole Proprietor?:No
Enumeration Date:2009-11-03
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT018369225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist