Provider Demographics
NPI:1649777442
Name:CRUZ, ANARELIS (PTA)
Entity Type:Individual
Prefix:
First Name:ANARELIS
Middle Name:
Last Name: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 1:5069 WALNUT RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8271
Mailing Address - Country:US
Mailing Address - Phone:321-303-6276
Mailing Address - Fax:321-235-7311
Practice Address - Street 1:5069 WALNUT RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-8271
Practice Address - Country:US
Practice Address - Phone:321-303-6276
Practice Address - Fax:321-235-7311
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA24501225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PTA24501OtherSTATE LICENSE