MEDICARE: MS. MARIA-LUISA C DELA CERNA PT

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	5501005717	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	65-0-F3-6114-0	OTHER	MI	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154414571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA-LUISA C DELA CERNA PT

Provider Business Mailing Address
First Line	:	2251 N SQUIRREL RD
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-4600
Country	:	US
Telephone Number	:	248-656-6757
Fax Number	:

Provider Business Practice Location Address
First Line	:	2251 N SQUIRREL RD STE 310
Second Line	:
City	:	AUBURN HILLS
State	:	MI
Zip	:	48326-4608
Country	:	US
Telephone Number	:	248-656-6757
Fax Number	:

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	10/26/2018

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