MEDICARE: TAMMY CRUZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	PTA 24505	FL
2	225200000X	Physical Therapy Assistant	2100840	TX

General Provider Information

NPI Number	:	1518389014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY CRUZ

Provider Business Mailing Address
First Line	:	8550 ARGYLE BUSINESS LOOP UNIT 1206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-8917
Country	:	US
Telephone Number	:	904-314-4471
Fax Number	:

Provider Business Practice Location Address
First Line	:	8550 ARGYLE BUSINESS LOOP UNIT 1206
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32244-8917
Country	:	US
Telephone Number	:	904-314-4471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/17/2014
Last Update Date	:	01/17/2014

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Directions to “ TAMMY CRUZ ” Practice Location

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