Provider Demographics
NPI:1023316569
Name:CUA, KENDRICK (PT)
Entity type:Individual
Prefix:
First Name:KENDRICK
Middle Name:
Last Name:CUA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 WOLF GLEN CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-9589
Mailing Address - Country:US
Mailing Address - Phone:910-545-6715
Mailing Address - Fax:
Practice Address - Street 1:146 STEWART POINT RD
Practice Address - Street 2:
Practice Address - City:HUBERT
Practice Address - State:NC
Practice Address - Zip Code:28539-3440
Practice Address - Country:US
Practice Address - Phone:910-326-3066
Practice Address - Fax:910-326-3231
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist