Provider Demographics
NPI:1235604489
Name:CUARESMA, JEDD (DPT)
Entity Type:Individual
Prefix:
First Name:JEDD
Middle Name:
Last Name:CUARESMA
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 1:7224 PORTIA CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-0247
Mailing Address - Country:US
Mailing Address - Phone:702-289-8048
Mailing Address - Fax:
Practice Address - Street 1:149 N GIBSON RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-6760
Practice Address - Country:US
Practice Address - Phone:702-558-6275
Practice Address - Fax:702-856-3198
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2021-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist