Provider Demographics
NPI:1649535196
Name:CERULLO, ASHLEY (PT)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:CERULLO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:
Other - Last Name:ROXAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:12261 W 159TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMER GLEN
Mailing Address - State:IL
Mailing Address - Zip Code:60491-7847
Mailing Address - Country:US
Mailing Address - Phone:708-301-2255
Mailing Address - Fax:
Practice Address - Street 1:12261 W 159TH ST
Practice Address - Street 2:
Practice Address - City:HOMER GLEN
Practice Address - State:IL
Practice Address - Zip Code:60491-7847
Practice Address - Country:US
Practice Address - Phone:708-301-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01190975OtherMEDICARE RR
ILP01285698OtherMEDICARE RAILROAD
ILIL3585011Medicare PIN
IL202845260Medicare PIN