Active NPI
Jillianne I De la Cruz, DPT
- Physical Therapist
- Beaufort, SC
National Provider Identifier
1760110464
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11484
- Practice address
- 1076 Ribaut Rd Ste 102
Beaufort, SC 29902-5490 - Phone
- (843) 525-0045
- Fax
- (843) 525-0826
- NPI assigned
- Aug 10, 2022
- Sex
- Female
- Sole proprietor
- No
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 | 11484 | SC | Primary |
Addresses
Primary practice location
1076 Ribaut Rd Ste 102
Beaufort, SC 29902-5490
Mailing address
1076 Ribaut Rd Ste 102
Beaufort, SC 29902-5490
Phone (843) 525-0045
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11484 | SC | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1660089600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1660262400000",
"number": "1760110464",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1076 RIBAUT RD STE 102",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025490",
"telephone_number": "843-525-0045",
"fax_number": "843-525-0826"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1076 RIBAUT RD STE 102",
"city": "BEAUFORT",
"state": "SC",
"postal_code": "299025490",
"telephone_number": "843-525-0045",
"fax_number": "843-525-0826"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LA CRUZ",
"first_name": "JILLIANNE",
"middle_name": "I",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-08-10",
"last_updated": "2022-08-12",
"certification_date": "2022-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "SC",
"license": "11484",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaufort, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.