Provider Demographics
NPI:1275761272
Name:HUERTA, SEGUNDO STEVEN (DPT)
Entity Type:Individual
Prefix:
First Name:SEGUNDO
Middle Name:STEVEN
Last Name:HUERTA
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 57970
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32241-7970
Mailing Address - Country:US
Mailing Address - Phone:904-448-2005
Mailing Address - Fax:904-448-1185
Practice Address - Street 1:4243 SUNBEAM RD
Practice Address - Street 2:SUITE 2
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8848
Practice Address - Country:US
Practice Address - Phone:904-448-2005
Practice Address - Fax:904-448-1185
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL 23132255A2300X
FLPT29010225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer