Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2305206561 | VA |
NPI | 1235475203 |
---|---|
Provider Name | Mary Kristine Sungahid Dela Cruz |
First Address | Colonial Heights, VA 23834-1614 |
Second Address | Hopewell, VA 23860-2717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2012 |
Last Update Date | 19/12/2012 |