Provider Demographics
NPI:1669945473
Name:NEIRA, JUAN SEBASTIAN (LAT, ATC, PES, CES)
Entity type:Individual
Prefix:
First Name:JUAN SEBASTIAN
Middle Name:
Last Name:NEIRA
Suffix:
Gender:M
Credentials:LAT, ATC, PES, CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 MASSEL AVE SE # A
Mailing Address - Street 2:
Mailing Address - City:VALDESE
Mailing Address - State:NC
Mailing Address - Zip Code:28690-2837
Mailing Address - Country:US
Mailing Address - Phone:305-345-3514
Mailing Address - Fax:
Practice Address - Street 1:274 MADISON AVE RM 201
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0717
Practice Address - Country:US
Practice Address - Phone:646-678-5995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program