Provider Demographics
NPI:1205976644
Name:NEVEUX, PATRICK R (PT)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:R
Last Name:NEVEUX
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 1:441 NW PRIMA VISTA BLVD.
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:772-873-8980
Mailing Address - Fax:772-873-8981
Practice Address - Street 1:1400 SE GOLDTREE DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952
Practice Address - Country:US
Practice Address - Phone:772-398-7678
Practice Address - Fax:772-398-7657
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT12114225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL889016100Medicaid
FLY917ZOtherBCBS
FL889016100Medicaid
FLK2704Medicare ID - Type UnspecifiedGROUP