Provider Demographics
NPI:1720144504
Name:CUELI-DUTIL, TRACY C (DPT)
Entity type:Individual
Prefix:DR
First Name:TRACY
Middle Name:C
Last Name:CUELI-DUTIL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16322 SW 14TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-5121
Mailing Address - Country:US
Mailing Address - Phone:954-383-4239
Mailing Address - Fax:954-435-2810
Practice Address - Street 1:55 WESTON RD
Practice Address - Street 2:SUITE #103
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1169
Practice Address - Country:US
Practice Address - Phone:954-383-4239
Practice Address - Fax:954-435-2810
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT170752251N0400X, 2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2251N0400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistNeurology
Not Answered2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY8749OtherBCBS PROVIDER NUMBER