Provider Demographics
NPI:1467436204
Name:AQUINO, REY TEOFILO CRUZ (PT MPT)
Entity Type:Individual
Prefix:
First Name:REY
Middle Name:TEOFILO CRUZ
Last Name:AQUINO
Suffix:
Gender:M
Credentials:PT MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2091 W FLORIDA AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-4800
Mailing Address - Country:US
Mailing Address - Phone:951-570-6468
Mailing Address - Fax:951-658-0009
Practice Address - Street 1:2091 W FLORIDA AVE STE 210
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-4800
Practice Address - Country:US
Practice Address - Phone:951-658-0005
Practice Address - Fax:951-658-0009
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT22025225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP775ZMedicare PIN
CA0PT220250OtherBLUE SHIELD
CAAP775ZMedicare PIN