Provider Demographics
NPI:1245677269
Name:CECILIO, CHRISTOPHER PHILLIP CORTEZ (PT)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER PHILLIP
Middle Name:CORTEZ
Last Name:CECILIO
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2503 W SPRINGFIELD AVE
Mailing Address - Street 2:APARTMENT G-1
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-2846
Mailing Address - Country:US
Mailing Address - Phone:240-938-2328
Mailing Address - Fax:
Practice Address - Street 1:214 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2598
Practice Address - Country:US
Practice Address - Phone:417-782-2917
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2013-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.019838225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist