Provider Demographics
NPI:1699104554
Name:CIESLA, VALERIE (PT)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:CIESLA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 TRANSIT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-2540
Mailing Address - Country:US
Mailing Address - Phone:770-721-8160
Mailing Address - Fax:
Practice Address - Street 1:720 TRANSIT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-2540
Practice Address - Country:US
Practice Address - Phone:770-721-8160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT006345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist