Provider Demographics
NPI:1770237166
Name:CRUZ, JOEL DENNIS
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:DENNIS
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6041 STRAFFORD OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33875-4780
Mailing Address - Country:US
Mailing Address - Phone:863-446-1180
Mailing Address - Fax:
Practice Address - Street 1:6041 STRAFFORD OAKS DR
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33875-4780
Practice Address - Country:US
Practice Address - Phone:863-446-1180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15495225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist