Healthcare Provider Details

I. General information

NPI: 1093227449
Provider Name (Legal Business Name): JOAQUIN CUEVAS DIMANLIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2017
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 BILLINGSLEY RD STE 103
CHARLOTTE NC
28211-1066
US

IV. Provider business mailing address

515 JORDAN PL APT 100-B
CHARLOTTE NC
28205-2694
US

V. Phone/Fax

Practice location:
  • Phone: 704-577-3186
  • Fax:
Mailing address:
  • Phone: 954-393-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number32702
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: