Healthcare Provider Details

I. General information

NPI: 1720456833
Provider Name (Legal Business Name): LUCKY LEONARDO CUARTERO PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2015
Last Update Date: 09/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 SAWGRASS CORPORATE PKWY SUITE 100
SUNRISE FL
33323-2859
US

IV. Provider business mailing address

1580 SAWGRASS CORPORATE PKWY SUITE 100
SUNRISE FL
33323-2859
US

V. Phone/Fax

Practice location:
  • Phone: 954-332-4445
  • Fax: 866-422-6431
Mailing address:
  • Phone: 954-332-4445
  • Fax: 866-422-6431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1258629
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.021799
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: