Provider Demographics
NPI:1497071104
Name:COURET, JESUS DELA (LMT)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:DELA
Last Name:COURET
Suffix:
Gender:M
Credentials:LMT
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Mailing Address - Street 1:1395 W SUNRISE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-7076
Mailing Address - Country:US
Mailing Address - Phone:954-616-5849
Mailing Address - Fax:954-616-5851
Practice Address - Street 1:1395 W SUNRISE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-7076
Practice Address - Country:US
Practice Address - Phone:954-616-5849
Practice Address - Fax:954-616-5851
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLMA26430225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist