Basic Information
| Provider Information | |||||||||
| NPI: | 1508923905 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | ELISA | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1002 TEXAS BLVD STE 406 | ||||||||
| Address2: | ATTENTION PT DEPT | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037944198 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 TEXAS BLVD STE 406 | ||||||||
| Address2: | ATTENTION PT DEPT | ||||||||
| City: | TEXARKANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 755015113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9037944196 | ||||||||
| FaxNumber: | 9037944198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1080893 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 8T6171 | 01 | TX | BCBS OF TEXAS | OTHER | 83869 | 01 | AR | BCBS ARKANSAS PROV # | OTHER |