Provider Demographics
NPI:1205020047
Name:CUEVAS, JEFFREY C (LPT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:C
Last Name:CUEVAS
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 MYSTIC LN
Mailing Address - Street 2:
Mailing Address - City:NACOGDOCHES
Mailing Address - State:TX
Mailing Address - Zip Code:75965-6515
Mailing Address - Country:US
Mailing Address - Phone:936-569-0314
Mailing Address - Fax:
Practice Address - Street 1:838 N UNIVERSITY
Practice Address - Street 2:SUITE 100
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4898
Practice Address - Country:US
Practice Address - Phone:936-552-7044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1101582225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2798OtherPROVIDOR NUMBER
TX7532355OtherAETNA ID NUMBER
TX170790301Medicaid
TX8T0396OtherBCBS PROVIDOR NUMBER