Provider Demographics
NPI:1669503660
Name:MANUEL, RENELITA CRUZ (PT)
Entity Type:Individual
Prefix:
First Name:RENELITA
Middle Name:CRUZ
Last Name:MANUEL
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 1:153 CANNON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4607
Mailing Address - Country:US
Mailing Address - Phone:718-690-4238
Mailing Address - Fax:718-494-6329
Practice Address - Street 1:330 SEGUINE AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10309-3941
Practice Address - Country:US
Practice Address - Phone:718-356-9222
Practice Address - Fax:718-605-4729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024777225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist