Healthcare Provider Details

I. General information

NPI: 1821552779
Provider Name (Legal Business Name): TAMARA DELA CRUZ PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 ALDEN BRIDGE DR
SPRING TX
77382-5121
US

IV. Provider business mailing address

1514 GRAYSTONE HILLS DR
CONROE TX
77304-2374
US

V. Phone/Fax

Practice location:
  • Phone: 832-510-7537
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2085003
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: