Provider Demographics
NPI:1376108597
Name:CRUISE, KAREN DZIERSKI (PT)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:DZIERSKI
Last Name:CRUISE
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 1:431 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-5378
Mailing Address - Country:US
Mailing Address - Phone:805-404-7128
Mailing Address - Fax:
Practice Address - Street 1:10860 TOPANGA CANYON BLVD
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-1350
Practice Address - Country:US
Practice Address - Phone:818-700-2971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT106912251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics