MEDICARE: MARIA FERNANDA CUELLAR PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT18972	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508113952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA FERNANDA CUELLAR PT

Provider Business Mailing Address
First Line	:	PO BOX 880594
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34988-0594
Country	:	US
Telephone Number	:	772-446-9047
Fax Number	:	772-879-6650

Provider Business Practice Location Address
First Line	:	8414 S FEDERAL HWY
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34952-3306
Country	:	US
Telephone Number	:	772-446-9047
Fax Number	:	772-879-6650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2012
Last Update Date	:	12/29/2020

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