Provider Demographics
NPI:1588447320
Name:CRUZ, RYAN NICHOLAS (DPT)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:NICHOLAS
Last Name:CRUZ
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6311 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-1551
Mailing Address - Country:US
Mailing Address - Phone:602-837-0957
Mailing Address - Fax:602-595-9662
Practice Address - Street 1:6311 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-1551
Practice Address - Country:US
Practice Address - Phone:602-837-0957
Practice Address - Fax:602-595-9662
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-33166225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist