Provider Demographics
NPI:1811915531
Name:CERDA, SEBASTIAN S (RPT)
Entity type:Individual
Prefix:MR
First Name:SEBASTIAN
Middle Name:S
Last Name:CERDA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41278 MARGARITA ROAD
Mailing Address - Street 2:SUITE 102 CHOICE PHYSICAL THERAPY INC
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591
Mailing Address - Country:US
Mailing Address - Phone:951-587-8105
Mailing Address - Fax:951-587-8405
Practice Address - Street 1:41278 MARGARITA ROAD
Practice Address - Street 2:SUITE 102 CHOICE PHYSICAL THERAPY INC
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591
Practice Address - Country:US
Practice Address - Phone:951-587-8105
Practice Address - Fax:951-587-8405
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15658225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ29191ZOtherMEDICARE GROUP NUMBER
PT15658OtherCA STATE LIC NUMBER
PT15658OtherCA STATE LIC NUMBER
CA0PT156580Medicare ID - Type Unspecified