Provider Demographics
NPI:1831466721
Name:CRUZ ROSA, WANDA I (DPT)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:I
Last Name:CRUZ ROSA
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2839
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-2839
Mailing Address - Country:US
Mailing Address - Phone:787-585-7125
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 125 KM 21.9
Practice Address - Street 2:EDIFICIO SAN SEBASTIAN MEDICAL CENTER
Practice Address - City:SAN SEBASTIAN
Practice Address - State:PR
Practice Address - Zip Code:00685-0000
Practice Address - Country:US
Practice Address - Phone:787-926-1790
Practice Address - Fax:787-926-1790
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist