Healthcare Provider Details

I. General information

NPI: 1679491633
Provider Name (Legal Business Name): PAOLO ROMAN CRUZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 LITTLE RIVER TPKE STE 1000
ANNANDALE VA
22003-2629
US

IV. Provider business mailing address

672 N GLEBE RD APT 622
ARLINGTON VA
22203-2172
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-5681
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: