Provider Demographics
NPI:1073738290
Name:CUBA, LAWRENCE JAMES III (MPT, ATP)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:JAMES
Last Name:CUBA
Suffix:III
Gender:M
Credentials:MPT, ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1407 MARBLEHEAD CT
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-2086
Mailing Address - Country:US
Mailing Address - Phone:910-350-6764
Mailing Address - Fax:
Practice Address - Street 1:1407 MARBLEHEAD CT
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28412-2086
Practice Address - Country:US
Practice Address - Phone:910-520-3758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2789225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist