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General NPI Number Information
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NPI Number | 1750860003
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Entity Type | Individual
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Provider Name | NATHALIE MICHELLE ROSALES DELA CRUZ PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 08/08/2018
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Last Update Date | 05/05/2021
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Provider Practice Location Address
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Address Line | 545 OLD NORCROSS RD STE 100
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046
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Country | US
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Telephone | 678-377-2833
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Fax | 678-377-2882
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Provider Business Mailing Address
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Address Line | 3131 N DRUID HILLS RD APT 3205
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City | DECATUR
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State | GA
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Zip | 30033-2647
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Country | US
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Telephone | 561-376-9733
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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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 | PT013593
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License Number State | GA
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