Provider Demographics
NPI:1376134387
Name:DE LA CRUZ, DIANA RAQUEL (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:RAQUEL
Last Name:DE LA CRUZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 PROFESSIONAL PL STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH ENGLEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2293
Mailing Address - Country:US
Mailing Address - Phone:301-306-4500
Mailing Address - Fax:
Practice Address - Street 1:8200 PROFESSIONAL PL STE 101
Practice Address - Street 2:
Practice Address - City:NORTH ENGLEWOOD
Practice Address - State:MD
Practice Address - Zip Code:20785-2293
Practice Address - Country:US
Practice Address - Phone:301-306-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic