Provider Demographics
NPI:1750424198
Name:BERUBE, CECILE L (PT)
Entity type:Individual
Prefix:MS
First Name:CECILE
Middle Name:L
Last Name:BERUBE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 SUTTON ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-1620
Mailing Address - Country:US
Mailing Address - Phone:978-685-8059
Mailing Address - Fax:978-685-6421
Practice Address - Street 1:231 SUTTON ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-1620
Practice Address - Country:US
Practice Address - Phone:978-685-8059
Practice Address - Fax:978-685-6421
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA1857225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0397971Medicaid
MABEY65870OtherBLUE CROSS
MABEY68390Medicare PIN