Healthcare Provider Details

I. General information

NPI: 1407750102
Provider Name (Legal Business Name): CHRISTOPHER CRUZ Y CORRO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 HILL WAY UNIT 10A
CAPE ELIZABETH ME
04107-2036
US

IV. Provider business mailing address

723 RIVERSIDE ST
PORTLAND ME
04103-5916
US

V. Phone/Fax

Practice location:
  • Phone: 207-799-9950
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT7565
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: