Provider Demographics
NPI:1013506682
Name:CUMBERBATCH, JULES GORDON (LMT)
Entity Type:Individual
Prefix:MR
First Name:JULES
Middle Name:GORDON
Last Name:CUMBERBATCH
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13842 BUFFALO VLY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78252-1715
Mailing Address - Country:US
Mailing Address - Phone:210-992-7053
Mailing Address - Fax:
Practice Address - Street 1:13842 BUFFALO VLY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78252-1715
Practice Address - Country:US
Practice Address - Phone:210-992-7053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT134657225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist