Provider Demographics
NPI:1073813697
Name:CRUZ, MARIA CECILIA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CECILIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 WOODVALE AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10309-3527
Mailing Address - Country:US
Mailing Address - Phone:646-591-7068
Mailing Address - Fax:718-967-4325
Practice Address - Street 1:236 WOODVALE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3527
Practice Address - Country:US
Practice Address - Phone:646-591-7068
Practice Address - Fax:718-967-4325
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-29
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027049-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics