Provider Demographics
NPI:1871782292
Name:CELSO, BETHANY MARIE (MSPT)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:MARIE
Last Name:CELSO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GREENBRIAR CT
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08016-4360
Mailing Address - Country:US
Mailing Address - Phone:609-386-2333
Mailing Address - Fax:
Practice Address - Street 1:2716 ORTHODOX ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19137-1604
Practice Address - Country:US
Practice Address - Phone:215-743-4435
Practice Address - Fax:215-743-8848
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00940100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ062944PN1Medicare PIN