Provider Demographics
NPI:1134599483
Name:ROLDAN, MA. CECILIA (PT)
Entity type:Individual
Prefix:
First Name:MA. CECILIA
Middle Name:
Last Name:ROLDAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MA CECILIA
Other - Middle Name:SORIANO
Other - Last Name:ROLDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1555 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-9492
Mailing Address - Country:US
Mailing Address - Phone:317-261-7844
Mailing Address - Fax:
Practice Address - Street 1:1555 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9492
Practice Address - Country:US
Practice Address - Phone:317-261-7844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05009151A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist