Provider Demographics
NPI:1558080556
Name:CRUZ, GIAN CARLO (PT)
Entity type:Individual
Prefix:
First Name:GIAN
Middle Name:CARLO
Last Name:CRUZ
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 CAMINO VILLA APT 512
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5622
Mailing Address - Country:US
Mailing Address - Phone:432-940-4652
Mailing Address - Fax:
Practice Address - Street 1:1901 BABCOCK RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4554
Practice Address - Country:US
Practice Address - Phone:210-680-5033
Practice Address - Fax:210-680-6094
Is Sole Proprietor?:No
Enumeration Date:2022-08-23
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1367247225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist