Provider Demographics
NPI:1346579604
Name:CELESTINO, CLARISSA
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:
Last Name:CELESTINO
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 1:7307 S VIA TIERRA MESA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85756-0016
Mailing Address - Country:US
Mailing Address - Phone:323-572-6468
Mailing Address - Fax:
Practice Address - Street 1:2100 N WILMOT RD STE 201
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-3075
Practice Address - Country:US
Practice Address - Phone:801-942-3311
Practice Address - Fax:801-942-5955
Is Sole Proprietor?:No
Enumeration Date:2009-12-16
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT32050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist