Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251N0400X | Physical Therapist - Neurology | PT17075 | FL |
N | 2251P0200X | Physical Therapist - Pediatrics | PT17075 | FL |
NPI | 1720144504 |
---|---|
Provider Name | Dr. Tracy C. Cueli-Dutil |
First Address | Pembroke Pines, FL 33027-5121 |
Second Address | Weston, FL 33326-1169 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Y8749 | BCBS PROVIDER NUMBER (01) | FL |