Provider Demographics
NPI:1871827733
Name:CRUZ, RAICHELLE (DPT)
Entity Type:Individual
Prefix:MISS
First Name:RAICHELLE
Middle Name:
Last Name:CRUZ
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 1:9827 SEED ST
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-6762
Mailing Address - Country:US
Mailing Address - Phone:610-442-8463
Mailing Address - Fax:
Practice Address - Street 1:950 TRAVELERS BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8287
Practice Address - Country:US
Practice Address - Phone:843-832-8481
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-25
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305205406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist