Provider Demographics
NPI:1487364428
Name:CELESTINE, SHYRECE
Entity type:Individual
Prefix:
First Name:SHYRECE
Middle Name:
Last Name:CELESTINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 CHAMBLEE TUCKER RD UNIT 941084
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31141-5005
Mailing Address - Country:US
Mailing Address - Phone:337-274-6953
Mailing Address - Fax:
Practice Address - Street 1:75 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4381
Practice Address - Country:US
Practice Address - Phone:337-274-6953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-30
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT016137225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist