Provider Demographics
NPI:1538638937
Name:CRUZ, ROSANNA DIONISIO (PT)
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:DIONISIO
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROSANNA
Other - Middle Name:MARCELO
Other - Last Name:DIONISIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7251 ENGLE RD STE 350
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3419
Mailing Address - Country:US
Mailing Address - Phone:877-241-5783
Mailing Address - Fax:
Practice Address - Street 1:9615 KNOX AVE
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1219
Practice Address - Country:US
Practice Address - Phone:847-679-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.19060225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL070.19060OtherPT LICENSE