Provider Demographics
NPI:1639382567
Name:DE JESUS CRUZ, HILERY BETH (PTA)
Entity Type:Individual
Prefix:MS
First Name:HILERY
Middle Name:BETH
Last Name:DE JESUS CRUZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 DALLAS LN
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-6163
Mailing Address - Country:US
Mailing Address - Phone:214-448-2241
Mailing Address - Fax:
Practice Address - Street 1:924 DALLAS LN
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-6163
Practice Address - Country:US
Practice Address - Phone:214-448-2241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2046902225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant