=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023812674
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ESTEBAN CUITIVA PT, DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2025
-----------------------------------------------------
Last Update Date | 04/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 W 5TH ST
-----------------------------------------------------
City | PERU
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46970-2143
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-925-4416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18120 SW 148TH RD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33187-1856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-925-4416
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 42522
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 05015830A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------