Provider Demographics
NPI:1184971251
Name:CECIL, ADAM (DPT, ATC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:CECIL
Suffix:
Gender:M
Credentials:DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12630 ROCKROSE GLN
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD RANCH
Mailing Address - State:FL
Mailing Address - Zip Code:34202-2829
Mailing Address - Country:US
Mailing Address - Phone:301-904-2343
Mailing Address - Fax:
Practice Address - Street 1:12630 ROCKROSE GLN
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34202-2829
Practice Address - Country:US
Practice Address - Phone:301-904-2343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305207562225100000X
FLPT30530225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016628700Medicaid
FLII019ZMedicare PIN