MEDICARE: ANN HAZEL BUNAG CEBALLO 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	027891	NY

General Provider Information

NPI Number	:	1386823300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN HAZEL BUNAG CEBALLO PT

Provider Business Mailing Address
First Line	:	3290 N RIDGE RD
Second Line	:	SUITE 290
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-3655
Country	:	US
Telephone Number	:	410-750-9006
Fax Number	:	410-750-0787

Provider Business Practice Location Address
First Line	:	3201 W COMMERCIAL BLVD
Second Line	:	SUITE 116
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33309-3440
Country	:	US
Telephone Number	:	954-739-4247
Fax Number	:	186-642-2643

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

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	10/25/2007

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