=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740157064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SMART LIVING FLORIDA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2025
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 608 S MARKET AVE UNIT A
-----------------------------------------------------
City | FORT PIERCE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34982-6644
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-285-7557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 321 SW LAKE FOREST WAY
-----------------------------------------------------
City | PORT SAINT LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34986-2072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-577-9673
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MANAGER
-----------------------------------------------------
Name | MARIA FERNANDA CUELLAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-577-9673
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------