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General NPI Number Information
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NPI Number | 1205020047
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Entity Type | Individual
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Provider Name | JEFFREY C CUEVAS LPT
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Gender | Male
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Dates
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Enumeration Date | 09/05/2007
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Last Update Date | 11/08/2016
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Provider Practice Location Address
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Address Line | 838 N UNIVERSITY SUITE 100
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City | NACOGDOCHES
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State | TX
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Zip | 75961-4898
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Country | US
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Telephone | 936-552-7044
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Fax |
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Provider Business Mailing Address
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Address Line | 4000 MYSTIC LN
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City | NACOGDOCHES
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State | TX
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Zip | 75965-6515
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Country | US
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Telephone | 936-569-0314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1101582
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License Number State | TX
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