Provider Demographics
NPI:1669744785
Name:CRUZ, PETE (PT)
Entity type:Individual
Prefix:
First Name:PETE
Middle Name:
Last Name: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 1:3815 COVINGTON LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2760
Mailing Address - Country:US
Mailing Address - Phone:863-257-3286
Mailing Address - Fax:
Practice Address - Street 1:2355 VIDINA DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7698
Practice Address - Country:US
Practice Address - Phone:863-257-3286
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT22943225100000X
FLPT 22943225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist