Healthcare Provider Details

I. General information

NPI: 1083555437
Provider Name (Legal Business Name): JOSE JAVIER CRUZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

422 QUINCY ST NE
ALBUQUERQUE NM
87108-1347
US

IV. Provider business mailing address

422 QUINCY ST NE
ALBUQUERQUE NM
87108-1347
US

V. Phone/Fax

Practice location:
  • Phone: 714-716-6813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT-2026-0065
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: