Healthcare Provider Details

I. General information

NPI: 1134797681
Provider Name (Legal Business Name): MICHELA DE LA CUESTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MICHELA JULIANO

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 MIDDLESEX TPKE STE 101L
BEDFORD MA
01730-1417
US

IV. Provider business mailing address

54 MIDDLESEX TPKE STE 101L
BEDFORD MA
01730-1417
US

V. Phone/Fax

Practice location:
  • Phone: 781-229-8011
  • Fax: 781-229-8374
Mailing address:
  • Phone: 781-229-8011
  • Fax: 781-229-8374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: