Provider Demographics
NPI:1699433540
Name:CUEVAS GUERRA, GRETTEL
Entity type:Individual
Prefix:
First Name:GRETTEL
Middle Name:
Last Name:CUEVAS GUERRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9581 FONTAINEBLEAU BLVD APT 506
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-6849
Mailing Address - Country:US
Mailing Address - Phone:786-238-6450
Mailing Address - Fax:
Practice Address - Street 1:9581 FONTAINEBLEAU BLVD APT 506
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-6849
Practice Address - Country:US
Practice Address - Phone:786-238-6450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA31669225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant