MEDICARE: MR. ROBERT RYAN CRUZ SY PT

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	022079	NY
2	225100000X	Physical Therapist	PT5570	HI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902887334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT RYAN CRUZ SY PT

Provider Business Mailing Address
First Line	:	4211 WAIALAE AVE STE 303
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5316
Country	:	US
Telephone Number	:	845-636-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	4211 WAIALAE AVE STE 303
Second Line	:
City	:	HONOLULU
State	:	HI
Zip	:	96816-5316
Country	:	US
Telephone Number	:	845-636-3044
Fax Number	:

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

Provider Enumeration Date	:	11/11/2005
Last Update Date	:	03/03/2024

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