Provider Demographics
NPI:1114173242
Name:DEJESUS, JOSE LUIS (DPT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:DEJESUS
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:PO BOX 12909
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28561-2909
Mailing Address - Country:US
Mailing Address - Phone:910-938-7555
Mailing Address - Fax:910-938-7544
Practice Address - Street 1:122 BRANCHWOOD SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-5800
Practice Address - Country:US
Practice Address - Phone:910-938-7555
Practice Address - Fax:910-938-7544
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11763225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist