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General NPI Number Information
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NPI Number | 1114324811
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Entity Type | Individual
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Provider Name | JOSE M CRUSES PTA
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Gender | Male
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 06/29/2018
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Provider Practice Location Address
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Address Line | 1495 S VOLUSIA AVE STE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7047
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Country | US
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Telephone | 386-774-6100
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Fax | 386-960-0551
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Provider Business Mailing Address
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Address Line | 1495 S VOLUSIA AVE STE 101
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City | ORANGE CITY
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State | FL
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Zip | 32763-7047
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Country | US
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Telephone | 386-774-6100
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Fax | 386-960-0551
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA 25032
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License Number State | FL
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