MEDICARE: BEVERLY DE LA 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	225100000X	Physical Therapist	070019567	IL

General Provider Information

NPI Number	:	1629527155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEVERLY DE LA CRUZ

Provider Business Mailing Address
First Line	:	1302 N OAKMONT DR APT 304
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3637
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1302 N OAKMONT DR
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-3637
Country	:	US
Telephone Number	:	773-494-5194
Fax Number	:

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

Provider Enumeration Date	:	09/26/2016
Last Update Date	:	09/26/2016

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Directions to “ BEVERLY DE LA CRUZ ” Practice Location

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