Provider Demographics
NPI:1720582786
Name:CUESTA, DAISY (PT)
Entity Type:Individual
Prefix:MRS
First Name:DAISY
Middle Name:
Last Name:CUESTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:PROF
Other - First Name:DAISY
Other - Middle Name:REYES
Other - Last Name:CUESTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:5280 PETAL BROOK DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-3079
Mailing Address - Country:US
Mailing Address - Phone:989-493-9950
Mailing Address - Fax:
Practice Address - Street 1:1447 N HARRISON ST
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602-4727
Practice Address - Country:US
Practice Address - Phone:989-493-9950
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-22
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501005680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist