Provider Demographics
NPI:1285848549
Name:CRUZE, LEAH RENAE (DPT)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RENAE
Last Name:CRUZE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RENAE
Other - Last Name:HENTGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:111 17TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-5273
Mailing Address - Country:US
Mailing Address - Phone:320-762-6079
Mailing Address - Fax:320-762-6123
Practice Address - Street 1:111 17TH AVE E
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5273
Practice Address - Country:US
Practice Address - Phone:320-762-6079
Practice Address - Fax:320-762-6123
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN76962251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic