Provider Demographics
NPI:1073955852
Name:DELA CRUZ, MARIE CARMELLE QUEMADA (RPT)
Entity Type:Individual
Prefix:MRS
First Name:MARIE CARMELLE
Middle Name:QUEMADA
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:MARIE CARMELLE
Other - Middle Name:LASCANO
Other - Last Name:QUEMADA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 N PINE ISLAND RD
Mailing Address - Street 2:APARTMENT 1-404
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6520
Mailing Address - Country:US
Mailing Address - Phone:954-256-4647
Mailing Address - Fax:
Practice Address - Street 1:4011 N PINE ISLAND RD
Practice Address - Street 2:APARTMENT 1-404
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6520
Practice Address - Country:US
Practice Address - Phone:954-256-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT009587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist