Provider Demographics
NPI:1730417825
Name:CECILIO, CINDY SAN ESTEBAN (RPT)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:SAN ESTEBAN
Last Name:CECILIO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MS
Other - First Name:CINDY
Other - Middle Name:TALISAY
Other - Last Name:SAN ESTEBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:410 GINGER BEND DR
Mailing Address - Street 2:APARTMENT 101
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61822-3567
Mailing Address - Country:US
Mailing Address - Phone:314-225-4831
Mailing Address - Fax:
Practice Address - Street 1:410 GINGER BEND DR
Practice Address - Street 2:APARTMENT 101
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-3567
Practice Address - Country:US
Practice Address - Phone:314-225-4831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-01
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.017598225100000X
OHPT. 012715225100000X
KS11-04044225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist