Basic Information
| Provider Information | |||||||||
| NPI: | 1720269954 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CRUZ | ||||||||
| FirstName: | VIRGILIO | ||||||||
| MiddleName: | CUNAN | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3290 EXECUTIVE CENTER II NORTH RIDGE ROAD | ||||||||
| Address2: | SUITE 290 | ||||||||
| City: | ELLICOTT CITY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107509006 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3201 W. COMMERCIAL BLVD | ||||||||
| Address2: | SUITE 116 | ||||||||
| City: | FORT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543324445 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2007 | ||||||||
| LastUpdateDate: | 11/15/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | MA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.