MEDICARE: MRS. HEIDI JEANINE CEKLOSKY MPT

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	171W00000X	Contractor	PT010847	PA

General Provider Information

NPI Number	:	1770712408
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. HEIDI JEANINE CEKLOSKY MPT

Provider Business Mailing Address
First Line	:	410 SUNSET RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-1655
Country	:	US
Telephone Number	:	570-379-2385
Fax Number	:	570-379-2353

Provider Business Practice Location Address
First Line	:	410 SUNSET RD
Second Line	:
City	:	WAPWALLOPEN
State	:	PA
Zip	:	18660-1655
Country	:	US
Telephone Number	:	570-379-2385
Fax Number	:	570-379-2353

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

Provider Enumeration Date	:	07/02/2009
Last Update Date	:	07/02/2009

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