MEDICARE: MRS. KATHLEEN CEBO PT, DPT, ATC, VATL

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

General Provider Information

NPI Number	:	1639329394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN CEBO PT, DPT, ATC, VATL

Provider Business Mailing Address
First Line	:	776 OAK GROVE RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3728
Country	:	US
Telephone Number	:	757-389-7900
Fax Number	:

Provider Business Practice Location Address
First Line	:	776 OAK GROVE RD
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23320-3728
Country	:	US
Telephone Number	:	757-389-7900
Fax Number	:

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

Provider Enumeration Date	:	09/30/2008
Last Update Date	:	12/12/2020

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