Provider Demographics
NPI:1184926271
Name:WONG-CRUZ, SHIRLEY VICTORIA (PTA)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:VICTORIA
Last Name:WONG-CRUZ
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ROSE DR
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1136
Mailing Address - Country:US
Mailing Address - Phone:516-385-3442
Mailing Address - Fax:516-385-3442
Practice Address - Street 1:101 ROSE DR
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1136
Practice Address - Country:US
Practice Address - Phone:516-385-3442
Practice Address - Fax:516-385-3442
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY158001225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant