Healthcare Provider Details

I. General information

NPI: 1730380429
Provider Name (Legal Business Name): BRIAN JOSEPH CUDA DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRUDENTIAL DR
JACKSONVILLE FL
32207-8202
US

IV. Provider business mailing address

265 MAPLEWOOD DR
JACKSONVILLE FL
32259-4373
US

V. Phone/Fax

Practice location:
  • Phone: 904-202-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT22164
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: