Provider Demographics
NPI:1952587974
Name:ANTENORCRUZ, ALAN A (PT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:A
Last Name:ANTENORCRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:ALAN
Other - Middle Name:A
Other - Last Name:ANTENORCRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:PO BOX 1925
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-1925
Mailing Address - Country:US
Mailing Address - Phone:409-385-6052
Mailing Address - Fax:
Practice Address - Street 1:170 LAURIE LANE
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-1925
Practice Address - Country:US
Practice Address - Phone:409-385-6052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1037745225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist