Provider Demographics
NPI:1407928666
Name:CRUZ-COOPER, CHRISTINE ANNE (RPT)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:ANNE
Last Name:CRUZ-COOPER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:CHRISTINE
Other - Middle Name:ANNE
Other - Last Name:COOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPT
Mailing Address - Street 1:PO BOX 1502
Mailing Address - Street 2:6646 U.S. HWY 19
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-1502
Mailing Address - Country:US
Mailing Address - Phone:727-848-6747
Mailing Address - Fax:727-847-3107
Practice Address - Street 1:38051 PASCO AVE
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-4234
Practice Address - Country:US
Practice Address - Phone:727-848-6747
Practice Address - Fax:727-847-3107
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 40402251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5110OtherBLUE CROSS & BLUE SHIELD
FL070012601Medicaid