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Individual

MR. GLEN GOMEZ CRUZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PT

Contact information

Practice address
3100 CLUB DR, LAWRENCEVILLE, GA 30044-2591
(770) 923-3100
Mailing address
3605 GAINESWAY CT, DULUTH, GA 30096-1738
(678) 468-7703
(770) 497-6405

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT008454
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT008454
STATE OF GEORGIA PT BOARD
GA
Enumeration date
04/14/2008
Last updated
04/14/2008
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