Healthcare Provider Details

I. General information

NPI: 1730888439
Provider Name (Legal Business Name): KARA CUELLAR PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 N AVONDALE BLVD # 104
AVONDALE AZ
85392-5006
US

IV. Provider business mailing address

5039 N 128TH DR
LITCHFIELD PARK AZ
85340-4112
US

V. Phone/Fax

Practice location:
  • Phone: 602-933-0980
  • Fax:
Mailing address:
  • Phone: 623-670-3664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32759
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: