Provider Demographics
NPI:1699052654
Name:CRUZ, OLIMPIO KENNETH ESTEBAN (PT)
Entity type:Individual
Prefix:
First Name:OLIMPIO KENNETH
Middle Name:ESTEBAN
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 1:7545 HIGHMEADOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-4815
Mailing Address - Country:US
Mailing Address - Phone:713-244-9505
Mailing Address - Fax:
Practice Address - Street 1:7545 HIGHMEADOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-4815
Practice Address - Country:US
Practice Address - Phone:713-244-9505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1146360225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist