Provider Demographics
NPI:1407127541
Name:CUNANAN, NELSON TIAMZON
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:TIAMZON
Last Name:CUNANAN
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 1:5903 PAMPUS LN
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71112-4985
Mailing Address - Country:US
Mailing Address - Phone:318-965-6497
Mailing Address - Fax:
Practice Address - Street 1:5903 PAMPUS LN
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4985
Practice Address - Country:US
Practice Address - Phone:318-965-6497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-20
Last Update Date:2012-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAA8181225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant