MEDICARE: KATELYN CECIL

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	295895	CA

General Provider Information

NPI Number	:	1760180129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATELYN CECIL

Provider Business Mailing Address
First Line	:	9131 TIMOTHY LN
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92841-2408
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	35410 DEL REY
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92624-1814
Country	:	US
Telephone Number	:	949-496-5786
Fax Number	:

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

Provider Enumeration Date	:	02/15/2023
Last Update Date	:	02/15/2023

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Directions to “ KATELYN CECIL ” Practice Location

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