Provider Demographics
NPI:1982846044
Name:SANTA CLARA, ANNA KHRUZETTE C (PT)
Entity Type:Individual
Prefix:
First Name:ANNA KHRUZETTE
Middle Name:C
Last Name:SANTA CLARA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KHRUZETTE
Other - Middle Name:CABANCE
Other - Last Name:ARANGUREN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:BALTIMORE
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3742
Mailing Address - Country:US
Mailing Address - Phone:410-377-8900
Mailing Address - Fax:410-377-3156
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:BALTIMORE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3742
Practice Address - Country:US
Practice Address - Phone:410-377-8900
Practice Address - Fax:410-377-3156
Is Sole Proprietor?:No
Enumeration Date:2009-04-03
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21935OtherLICENSE NUMBER