Organization
NACOGDOCHES REHABILITATION GROUP, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFFREY C CUEVAS PT (PRESIDENT)
(936) 552-7044
Entity
Organization
Contact information
Practice address
3205 N UNIVERSITY DR, SUITE M, NACOGDOCHES, TX 75965-2683
(936) 552-7044
(936) 552-7050
Mailing address
3205 N UNIVERSITY DR, SUITE M, NACOGDOCHES, TX 75965-2683
(936) 552-7044
(936) 552-7050
Taxonomy
Speciality
Code
Description
License number
State
261QP2000X
Physical Therapy Clinic/Center
Primary
1101582
TX
261QP2000X
Physical Therapy Clinic/Center
1108322
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0049HV
BCBSTX PROVIDOR #
TX
05
—
170788701
—
TX
01
—
5856810001
MEDICARE SUPPLIER / DME#
TX
01
—
P00016007/DA2661
MEDICARE RAILROAD ID/GROU
TX
Enumeration date
09/08/2005
Last updated
03/05/2008
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