Provider Demographics
NPI:1134797681
Name:DE LA CUESTA, MICHELA
Entity type:Individual
Prefix:
First Name:MICHELA
Middle Name:
Last Name:DE LA CUESTA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:MICHELA
Other - Middle Name:
Other - Last Name:JULIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:576 BROADHOLLOW RD STE PROEX
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-5002
Mailing Address - Country:US
Mailing Address - Phone:631-359-5859
Mailing Address - Fax:631-396-0864
Practice Address - Street 1:31 W GROVE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1859
Practice Address - Country:US
Practice Address - Phone:508-947-5195
Practice Address - Fax:508-947-3447
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-11
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist