Provider Demographics
NPI:1932520376
Name:CRUISE, KALEB (DPT)
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:CRUISE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 US HIGHWAY 98 W STE 220
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32550-7231
Mailing Address - Country:US
Mailing Address - Phone:402-276-0918
Mailing Address - Fax:
Practice Address - Street 1:7720 US HIGHWAY 98 W STE 220
Practice Address - Street 2:
Practice Address - City:MIRAMAR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32550-7231
Practice Address - Country:US
Practice Address - Phone:402-276-0918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-03
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29235225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist