Provider Demographics
NPI:1306070305
Name:CUADRA, MICHELLE NESAS (PT)
Entity type:Individual
Prefix:MISS
First Name:MICHELLE NESAS
Middle Name:
Last Name:CUADRA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4014 62ND ST
Mailing Address - Street 2:APT 7J
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-4989
Mailing Address - Country:US
Mailing Address - Phone:917-470-0321
Mailing Address - Fax:
Practice Address - Street 1:4014 62ND ST
Practice Address - Street 2:APT 7J
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4989
Practice Address - Country:US
Practice Address - Phone:917-470-0321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030169225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist