Provider Demographics
NPI:1124757034
Name:MCLAIN, CECIBEL KARINA (AS, LPTA, LMT)
Entity type:Individual
Prefix:
First Name:CECIBEL
Middle Name:KARINA
Last Name:MCLAIN
Suffix:
Gender:F
Credentials:AS, LPTA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 S 400 E
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9521
Mailing Address - Country:US
Mailing Address - Phone:219-928-6740
Mailing Address - Fax:
Practice Address - Street 1:660 MORTHLAND DR STE D
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-4638
Practice Address - Country:US
Practice Address - Phone:219-928-6740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INMT21104001225700000X
IN06005993A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist