Healthcare Provider Details

I. General information

NPI: 1093282212
Provider Name (Legal Business Name): AMELIA CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 10/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 WATERMAN WAY
TAVARES FL
32778
US

IV. Provider business mailing address

1505 TRAVERTINE TER
SANFORD FL
32771-7731
US

V. Phone/Fax

Practice location:
  • Phone: 352-609-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number28689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: