Provider Demographics
NPI:1407036890
Name:CRUZ, BRIAN (MSPT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BEACH ST
Mailing Address - Street 2:SUITE 1 & 2
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2770
Mailing Address - Country:US
Mailing Address - Phone:401-348-1010
Mailing Address - Fax:401-348-9550
Practice Address - Street 1:55 BEACH ST
Practice Address - Street 2:SUITE 1 & 2
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2770
Practice Address - Country:US
Practice Address - Phone:401-348-1010
Practice Address - Fax:401-348-9550
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPT02117225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist