Provider Demographics
NPI:1952853533
Name:DELA CRUZ, ROLAND (PT)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:
Last Name:DELA CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 DEERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-7544
Mailing Address - Country:US
Mailing Address - Phone:936-689-5900
Mailing Address - Fax:
Practice Address - Street 1:166 DEERWOOD DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-7544
Practice Address - Country:US
Practice Address - Phone:936-689-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-28
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11709261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy