Provider Demographics
NPI:1427645191
Name:DE LA CRUZ, DAVID PETER (LMT, RMT)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:PETER
Last Name:DE LA CRUZ
Suffix:
Gender:M
Credentials:LMT, RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5807 LINDER LN
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-2534
Mailing Address - Country:US
Mailing Address - Phone:202-705-0718
Mailing Address - Fax:
Practice Address - Street 1:5807 LINDER LN
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-2534
Practice Address - Country:US
Practice Address - Phone:202-705-0718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMT2297225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist