Provider Demographics
NPI:1538496534
Name:CRUDA, NESTOR CAJES JR (RPT)
Entity type:Individual
Prefix:MR
First Name:NESTOR
Middle Name:CAJES
Last Name:CRUDA
Suffix:JR
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12800 VONN RD
Mailing Address - Street 2:APT 7301
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774-2560
Mailing Address - Country:US
Mailing Address - Phone:508-409-8695
Mailing Address - Fax:
Practice Address - Street 1:12800 VONN RD
Practice Address - Street 2:APT 7301
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-2560
Practice Address - Country:US
Practice Address - Phone:508-409-8695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-11
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7707225100000X
MA18622225100000X
FLPT24577225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist