Provider Demographics
NPI:1154086056
Name:CORDOVEZ, DENNIS CRUZ (DPT, PT, PTRP)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:CRUZ
Last Name:CORDOVEZ
Suffix:
Gender:M
Credentials:DPT, PT, PTRP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8034 47TH AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3548
Mailing Address - Country:US
Mailing Address - Phone:929-580-5029
Mailing Address - Fax:
Practice Address - Street 1:10814 72ND AVE STE 4
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-5301
Practice Address - Country:US
Practice Address - Phone:718-520-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-04
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041298225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist