Provider Demographics
NPI:1083213029
Name:CRUZ, ADRIAN CARLOS
Entity Type:Individual
Prefix:
First Name:ADRIAN
Middle Name:CARLOS
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2237 N COMMERCE PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3250
Mailing Address - Country:US
Mailing Address - Phone:954-888-6650
Mailing Address - Fax:954-888-6645
Practice Address - Street 1:2237 N COMMERCE PKWY STE 2
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3250
Practice Address - Country:US
Practice Address - Phone:954-888-6650
Practice Address - Fax:954-888-6645
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT36108225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist