Provider Demographics
NPI:1275741381
Name:CRUZ, JOSE W GALLO (PT)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:W GALLO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 JESSICA DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3682
Mailing Address - Country:US
Mailing Address - Phone:361-510-1963
Mailing Address - Fax:866-633-7147
Practice Address - Street 1:6129 JESSICA DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3682
Practice Address - Country:US
Practice Address - Phone:361-510-1963
Practice Address - Fax:866-633-7147
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist