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General NPI Number Information
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NPI Number | 1164416988
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Entity Type | Organization
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Legal Business Name | NACOGDOCHES REHABILITATION GROUP, INC
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Dates
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Enumeration Date | 09/08/2005
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Last Update Date | 03/05/2008
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Provider Practice Location Address
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Address Line | 3205 N UNIVERSITY DR SUITE M
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2683
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Country | US
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Telephone | 936-552-7044
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Fax | 936-552-7050
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Provider Business Mailing Address
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Address Line | 3205 N UNIVERSITY DR SUITE M
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2683
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Country | US
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Telephone | 936-552-7044
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Fax | 936-552-7050
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEFFREY C CUEVAS
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Credential | PT
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Telephone | 936-552-7044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1108322
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 1101582
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License Number State | TX
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