Healthcare Provider Details

I. General information

NPI: 1700226503
Provider Name (Legal Business Name): JACOB AARON CRUZE DPT, CSMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

591 NORTHSIDE DR NE STE 200
ALEXANDRIA MN
56308-5063
US

IV. Provider business mailing address

2773 SAILOR DR NE
ALEXANDRIA MN
56308-5578
US

V. Phone/Fax

Practice location:
  • Phone: 651-283-6894
  • Fax:
Mailing address:
  • Phone: 651-283-6894
  • Fax: 320-445-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9324
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9324
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: