Provider Demographics
NPI:1952689895
Name:CELDRAN, VINCENT RAGASAJO (NCLMT)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:RAGASAJO
Last Name:CELDRAN
Suffix:
Gender:M
Credentials:NCLMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 INWOOD DR
Mailing Address - Street 2:# 502
Mailing Address - City:WHEELING
Mailing Address - State:IL
Mailing Address - Zip Code:60090-6709
Mailing Address - Country:US
Mailing Address - Phone:847-261-4883
Mailing Address - Fax:
Practice Address - Street 1:200 INWOOD DR
Practice Address - Street 2:# 502
Practice Address - City:WHEELING
Practice Address - State:IL
Practice Address - Zip Code:60090-6709
Practice Address - Country:US
Practice Address - Phone:847-261-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.012970225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist