Provider Demographics
NPI:1215291422
Name:BERNAL-CRUZ, ROSE ANN DORINGO (PT, DPT)
Entity type:Individual
Prefix:
First Name:ROSE ANN
Middle Name:DORINGO
Last Name:BERNAL-CRUZ
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:ROSE ANN
Other - Middle Name:DORINGO
Other - Last Name:BERNAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3502 S MASON AVE
Mailing Address - Street 2:APARTMENT 1A
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-8541
Mailing Address - Country:US
Mailing Address - Phone:888-896-5284
Mailing Address - Fax:253-593-4376
Practice Address - Street 1:7411 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-7118
Practice Address - Country:US
Practice Address - Phone:253-474-8456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-02
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60199646225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist