Provider Demographics
NPI:1750628632
Name:CECIL, ROBERT A JR (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:CECIL
Suffix:JR
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 1:5120 DIXIE HWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-1702
Mailing Address - Country:US
Mailing Address - Phone:502-587-1236
Mailing Address - Fax:502-587-0318
Practice Address - Street 1:5120 DIXIE HWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-1702
Practice Address - Country:US
Practice Address - Phone:502-587-1236
Practice Address - Fax:502-587-0318
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006175225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist