Healthcare Provider Details

I. General information

NPI: 1861544959
Provider Name (Legal Business Name): MARIA CIELITO ALMA MACEDA BERIN P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CINDY MACEDA BERIN P.T.

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2536 INDUSTRIAL DRIVE SUITE 10-11
BLOOMINGTON IN
47303
US

IV. Provider business mailing address

341 S WOODFIELD LN
BLOOMINGTON IN
47403-9070
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-7529
  • Fax: 812-339-7529
Mailing address:
  • Phone: 812-825-8815
  • Fax: 812-825-8815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number05006267A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: