Provider Demographics
NPI:1740629963
Name:PEREZ CRUZ, GLORIA ISABEL (BS, MSPT)
Entity type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:ISABEL
Last Name:PEREZ CRUZ
Suffix:
Gender:F
Credentials:BS, MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 URB LAS NEREIDAS
Mailing Address - Street 2:
Mailing Address - City:CABO ROJO
Mailing Address - State:PR
Mailing Address - Zip Code:00623-8915
Mailing Address - Country:US
Mailing Address - Phone:787-207-0960
Mailing Address - Fax:787-834-3536
Practice Address - Street 1:29 NORTH STREET PERAL
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00681
Practice Address - Country:US
Practice Address - Phone:787-834-3536
Practice Address - Fax:787-834-3536
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1459225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist