Cruz, Glen Gomez

Cruz, Glen Gomez is an individual health care provider with primary practice located at 3100 Club Dr , Lawrenceville GA 30044-2591. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Cruz, Glen Gomez can be contacted via phone (770) 923-3100.

Contact Information

Primary practice address
3100 Club Dr Lawrenceville GA 30044-2591
Phone: (770) 923-3100
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT008454 Georgia

Profile Details

NPI number 1164696894
LBN Legal business name Cruz, Glen Gomez
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 14th, 2008
Last updated Apr 14th, 2008 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1164696894 NPPES
Georgia Other PT008454 STATE OF GEORGIA PT BOARD

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