Healthcare Provider Details

I. General information

NPI: 1629363080
Provider Name (Legal Business Name): MICHAEL CERRETO MS, CSC, LDR, EDU-K
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 06/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HUGUENOT RD SUITE D
MIDLOTHIAN VA
23113-2397
US

IV. Provider business mailing address

2500 CASTLE HILL RD
MIDLOTHIAN VA
23113-1150
US

V. Phone/Fax

Practice location:
  • Phone: 804-272-3927
  • Fax:
Mailing address:
  • Phone: 804-272-3927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: