Provider Demographics
NPI:1811254477
Name:CELLA, SANDRA THERESE (PTA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:THERESE
Last Name:CELLA
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:363 COLONIAL CIR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-3640
Mailing Address - Country:US
Mailing Address - Phone:630-208-4671
Mailing Address - Fax:
Practice Address - Street 1:2445 DEAN ST
Practice Address - Street 2:UNIT B
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-4828
Practice Address - Country:US
Practice Address - Phone:630-513-2700
Practice Address - Fax:630-513-2703
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.005761225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant