MEDICARE: DR. JASON DELA CRUZ DPT

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	225100000X	Physical Therapist	PT27514	FL

General Provider Information

NPI Number	:	1609201318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON DELA CRUZ DPT

Provider Business Mailing Address
First Line	:	4756 NORTH FEDERAL HIGHWAY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4756 N FEDERAL HWY
Second Line	:
City	:	LIGHTHOUSE POINT
State	:	FL
Zip	:	33064-6553
Country	:	US
Telephone Number	:	954-946-8877
Fax Number	:

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

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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