Provider Demographics
NPI:1326253394
Name:CUETO, MELVYNE D (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MELVYNE
Middle Name:D
Last Name:CUETO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 LEE DR
Mailing Address - Street 2:
Mailing Address - City:KOUTS
Mailing Address - State:IN
Mailing Address - Zip Code:46347-9423
Mailing Address - Country:US
Mailing Address - Phone:219-246-0604
Mailing Address - Fax:
Practice Address - Street 1:1200 ROOSEVELT PL UNIT A
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-3707
Practice Address - Country:US
Practice Address - Phone:219-548-4663
Practice Address - Fax:219-477-5920
Is Sole Proprietor?:No
Enumeration Date:2007-05-13
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05007592A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist