MEDICARE: MRS. CRISTINE A CEELY DPT, GCS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	18489	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043231822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CRISTINE A CEELY DPT, GCS

Provider Business Mailing Address
First Line	:	17817 CADDY DR
Second Line	:
City	:	DERWOOD
State	:	MD
Zip	:	20855-1005
Country	:	US
Telephone Number	:	301-963-8126
Fax Number	:

Provider Business Practice Location Address
First Line	:	6308 DEMOCRACY BLVD
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-1664
Country	:	US
Telephone Number	:	301-530-2383
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	07/08/2007

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