Provider Demographics
NPI:1376684605
Name:DELA CRUZ, TERESITA A (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:A
Last Name:DELA 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 1:94-1128 KAHUAMO ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-3419
Mailing Address - Country:US
Mailing Address - Phone:808-678-1029
Mailing Address - Fax:
Practice Address - Street 1:94-1128 KAHUAMO ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-3419
Practice Address - Country:US
Practice Address - Phone:808-678-1029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1312225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist