Individual
JOEL CRUZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
186 W PINE ST, SHELLEY, ID 83274-1235
(208) 680-4787
Mailing address
400 GRANT ST, BLACKFOOT, ID 83221-2119
(208) 680-4787
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT-7250
ID
225200000X
Physical Therapy Assistant
PTA-4520
ID
Other
Enumeration date
10/16/2018
Last updated
04/22/2024
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