Healthcare Provider Details

I. General information

NPI: 1730585787
Provider Name (Legal Business Name): GERALD DELACRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8128 FLORIDA BLVD
DENHAM SPRINGS LA
70726-7865
US

IV. Provider business mailing address

723 WORDSWORTH DR
BATON ROUGE LA
70810-1986
US

V. Phone/Fax

Practice location:
  • Phone: 225-791-8644
  • Fax:
Mailing address:
  • Phone: 225-288-1593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number03639F
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: