Provider Demographics
NPI:1265752893
Name:CRUZ, MICHELLE AYUN AYUN (PT)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:AYUN AYUN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-6601
Mailing Address - Country:US
Mailing Address - Phone:577-395-1975
Mailing Address - Fax:757-425-7180
Practice Address - Street 1:928 DIAMOND SPRINGS RD STE 103
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-6601
Practice Address - Country:US
Practice Address - Phone:577-395-1975
Practice Address - Fax:757-425-7180
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23191225100000X
VA2307001471225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist