Provider Demographics
NPI:1508923905
Name:CRUZ, ELISA F (PT)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:F
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 TEXAS BLVD STE 406
Mailing Address - Street 2:ATTENTION PT DEPT
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-5113
Mailing Address - Country:US
Mailing Address - Phone:903-794-4196
Mailing Address - Fax:903-794-4198
Practice Address - Street 1:1002 TEXAS BLVD STE 406
Practice Address - Street 2:ATTENTION PT DEPT
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-5113
Practice Address - Country:US
Practice Address - Phone:903-794-4196
Practice Address - Fax:903-794-4198
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1080893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T6171OtherBCBS OF TEXAS
AR83869OtherBCBS ARKANSAS PROV #
TX8T6171OtherBCBS OF TEXAS
TX865015Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER