Provider Demographics
NPI:1275587651
Name:CRUZ, CATHERINE COREY (PT)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:COREY
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 1:2550 RAVENHILL DRIVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-9627
Mailing Address - Country:US
Mailing Address - Phone:910-484-8492
Mailing Address - Fax:910-484-2629
Practice Address - Street 1:2550 RAVENHILL DR
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-9627
Practice Address - Country:US
Practice Address - Phone:910-484-8492
Practice Address - Fax:910-484-2629
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6364225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
2508650Medicare ID - Type Unspecified