Healthcare Provider Details

I. General information

NPI: 1659774818
Provider Name (Legal Business Name): CLAIRE CUA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2014
Last Update Date: 10/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PROVIDENT DR
WARSAW IN
46580-3252
US

IV. Provider business mailing address

11384 CROCUS COURT
PLYMOUTH IN
46563
US

V. Phone/Fax

Practice location:
  • Phone: 574-371-2500
  • Fax: 765-664-5403
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008299A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: