Provider Demographics
NPI:1619789278
Name:CELESTINO, EREDIO III (PT, DPT)
Entity type:Individual
Prefix:
First Name:EREDIO
Middle Name:
Last Name:CELESTINO
Suffix:III
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 SIGNAL WAY APT 3314
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-1499
Mailing Address - Country:US
Mailing Address - Phone:732-882-4506
Mailing Address - Fax:
Practice Address - Street 1:11109 SIGNAL WAY APT 3314
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-1499
Practice Address - Country:US
Practice Address - Phone:732-882-4506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1403121225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist