Healthcare Provider Details

I. General information

NPI: 1073084331
Provider Name (Legal Business Name): JOSEPH CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 LIMESTONE RD STE 100
WILMINGTON DE
19808-2147
US

IV. Provider business mailing address

475 ALLENDALE RD STE 206
KING OF PRUSSIA PA
19406-1431
US

V. Phone/Fax

Practice location:
  • Phone: 302-239-2800
  • Fax:
Mailing address:
  • Phone: 610-270-0370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: