Provider Demographics
NPI:1649799941
Name:DELA CRUZ, MA. ANTOINETTE ATAS (PHYSICAL THERAPY)
Entity type:Individual
Prefix:DR
First Name:MA. ANTOINETTE
Middle Name:ATAS
Last Name:DELA CRUZ
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
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Mailing Address - Street 1:341 HILLSIDE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NJ
Mailing Address - Zip Code:08759-5670
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1579 OLD FREEHOLD RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2173
Practice Address - Country:US
Practice Address - Phone:732-505-4477
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-18
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00772700225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist