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General NPI Number Information
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NPI Number | 1346321536
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Entity Type | Individual
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Provider Name | WILMA CRUZ BOCALAN RPT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA GULF COAST VETERANS HEALTH CARE SYSTEM 400 VETERANS AVENUE
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City | BILOXI
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State | MS
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Zip | 39531
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Country | US
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Telephone | 228-523-5016
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Fax |
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Provider Business Mailing Address
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Address Line | 251 EISENHOWER DR APT #134
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City | BILOXI
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State | MS
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Zip | 39531-3618
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Country | US
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Telephone | 228-235-7089
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Fax |
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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 | PT22956
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License Number State | FL
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