Provider Demographics
NPI:1942731179
Name:CECIL, ROBERT (LAC,PTA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:CECIL
Suffix:
Gender:M
Credentials:LAC,PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 SAINT JOHN RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2918
Mailing Address - Country:US
Mailing Address - Phone:270-769-3314
Mailing Address - Fax:
Practice Address - Street 1:3044 RING RD
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7932
Practice Address - Country:US
Practice Address - Phone:270-506-3853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA03453225200000X
KYAC128171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY225200000XMedicare UPIN