Active NPI
Mark Oliver Magno Cruz, PTR
- Physical Therapist
- Crown Point, IN
National Provider Identifier
1669788691
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 05008235A
- Practice address
- 6685 E 117TH Ave
Crown Point, IN 46307-7808 - Phone
- (219) 663-6392
- NPI assigned
- Aug 27, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 05008235A | IN | Primary |
Addresses
Primary practice location
6685 E 117TH Ave
Crown Point, IN 46307-7808
Mailing address
6685 E 117TH Ave
Crown Point, IN 46307-7808
Phone (219) 663-6392
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 05008235A | IN | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1282867200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1282867200000",
"number": "1669788691",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6685 E 117TH AVE",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463077808",
"telephone_number": "219-663-6392"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6685 E 117TH AVE",
"city": "CROWN POINT",
"state": "IN",
"postal_code": "463077808",
"telephone_number": "219-663-6392"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRUZ",
"first_name": "MARK OLIVER",
"middle_name": "MAGNO",
"credential": "PTR",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-08-27",
"last_updated": "2010-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "IN",
"license": "05008235A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Crown Point, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.