Provider Demographics
NPI:1013375443
Name:CUADRA, ARMEN BRYAN (DPT)
Entity Type:Individual
Prefix:
First Name:ARMEN
Middle Name:BRYAN
Last Name:CUADRA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 LAVA RIDGE CT
Mailing Address - Street 2:SUITE 330
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3094
Mailing Address - Country:US
Mailing Address - Phone:916-367-9909
Mailing Address - Fax:
Practice Address - Street 1:3001 LAVA RIDGE CT
Practice Address - Street 2:SUITE 330
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3094
Practice Address - Country:US
Practice Address - Phone:916-367-9909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-30
Last Update Date:2016-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34963225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist