MEDICARE: MRS. SANDRA THERESE CELLA PTA

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	225200000X	Physical Therapy Assistant	160.005761	IL

General Provider Information

NPI Number	:	1811254477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SANDRA THERESE CELLA PTA

Provider Business Mailing Address
First Line	:	363 COLONIAL CIR
Second Line	:
City	:	GENEVA
State	:	IL
Zip	:	60134-3640
Country	:	US
Telephone Number	:	630-208-4671
Fax Number	:

Provider Business Practice Location Address
First Line	:	2445 DEAN ST
Second Line	:	UNIT B
City	:	ST CHARLES
State	:	IL
Zip	:	60175-4828
Country	:	US
Telephone Number	:	630-513-2700
Fax Number	:	630-513-2703

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

Provider Enumeration Date	:	04/19/2012
Last Update Date	:	04/19/2012

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