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General NPI Number Information
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NPI Number | 1265752893
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Entity Type | Individual
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Provider Name | MICHELLE AYUN AYUN CRUZ PT
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Gender | Female
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Dates
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Enumeration Date | 06/05/2010
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 928 DIAMOND SPRINGS RD STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6601
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Country | US
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Telephone | 577-395-1975
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Fax | 757-425-7180
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Provider Business Mailing Address
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Address Line | 928 DIAMOND SPRINGS RD STE 103
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City | VIRGINIA BEACH
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State | VA
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Zip | 23455-6601
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Country | US
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Telephone | 577-395-1975
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Fax | 757-425-7180
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 23191
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2307001471
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License Number State | VA
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