Provider Demographics
NPI:1275013377
Name:CUDERA, RAPHAEL RICARDO
Entity Type:Individual
Prefix:
First Name:RAPHAEL RICARDO
Middle Name:
Last Name:CUDERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 CENTRAL TEXAS EXPY
Mailing Address - Street 2:
Mailing Address - City:LAMPASAS
Mailing Address - State:TX
Mailing Address - Zip Code:76550-3382
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 CENTRAL TEXAS EXPY
Practice Address - Street 2:
Practice Address - City:LAMPASAS
Practice Address - State:TX
Practice Address - Zip Code:76550
Practice Address - Country:US
Practice Address - Phone:512-556-8827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1215676225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist