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General NPI Number Information
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NPI Number | 1063126209
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Entity Type | Organization
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Legal Business Name | CRUZ THERAPY SERVICES
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Dates
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Enumeration Date | 01/12/2023
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Last Update Date | 03/12/2025
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Provider Practice Location Address
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Address Line | 186 W PINE ST
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City | SHELLEY
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State | ID
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Zip | 83274-1235
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Country | US
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Telephone | 208-680-4787
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Fax |
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Provider Business Mailing Address
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Address Line | 400 GRANT ST
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City | BLACKFOOT
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State | ID
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Zip | 83221-2119
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Country | US
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Telephone | 208-680-4787
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOEL CRUZ
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Credential | DPT
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Telephone | 208-932-0108
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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