Provider Demographics
NPI:1083672828
Name:CEGLIA, JOHN LEONARD (PT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LEONARD
Last Name:CEGLIA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 HITCH DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-9652
Mailing Address - Country:US
Mailing Address - Phone:831-636-5658
Mailing Address - Fax:
Practice Address - Street 1:320 4TH ST
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3831
Practice Address - Country:US
Practice Address - Phone:831-638-4860
Practice Address - Fax:831-638-4864
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT10074225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist