Provider Demographics
NPI:1972202398
Name:CERENZO, PETER (MS, LAT, ATC, CES)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:CERENZO
Suffix:
Gender:M
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6012 WASHINGTON LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-2436
Mailing Address - Country:US
Mailing Address - Phone:609-217-1522
Mailing Address - Fax:
Practice Address - Street 1:6012 WASHINGTON LN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-2436
Practice Address - Country:US
Practice Address - Phone:609-217-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-24
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0070302255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer