Provider Demographics
NPI:1811589930
Name:CRUZ, MIGUEL CARLOS
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:CARLOS
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 1:1003 LINDSEY LN
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-5674
Mailing Address - Country:US
Mailing Address - Phone:936-240-4530
Mailing Address - Fax:
Practice Address - Street 1:1003 LINDSEY LN
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-5674
Practice Address - Country:US
Practice Address - Phone:936-240-4530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1219008225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1219008OtherECPTOTE PHYSICAL THERAPY LICENSCE