Provider Demographics
NPI:1457367146
Name:PEDERSEN, CELESTE (PT)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:
Last Name:PEDERSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:583 ZION RD
Mailing Address - Street 2:
Mailing Address - City:BIRDSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19508-8236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:71 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:STEVENS
Practice Address - State:PA
Practice Address - Zip Code:17578-9203
Practice Address - Country:US
Practice Address - Phone:717-336-5262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT008657L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist