Active NPI
Jay Emmanuel De la Cruz
- Physical Therapist
- Roxboro, NC
National Provider Identifier
1952880304
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 11511
- Practice address
- 5660 Durham Rd
Roxboro, NC 27574-7958 - Phone
- (336) 598-4697
- NPI assigned
- Aug 7, 2018
- Last updated
- May 5, 2020
- 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 | 11511 | NC | Primary |
Addresses
Primary practice location
5660 Durham Rd
Roxboro, NC 27574-7958
Mailing address
2000 Muddy Creek CT
Raleigh, NC 27610-3780
Phone (919) 400-8940
Other practice location 1
403 Crestview Ave SW
Wilson, NC 27893-4505
Phone (252) 237-0724
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 |
|---|---|---|---|
| 11511 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1533600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1588636800000",
"number": "1952880304",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 MUDDY CREEK CT",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276103780",
"telephone_number": "919-400-8940"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5660 DURHAM RD",
"city": "ROXBORO",
"state": "NC",
"postal_code": "275747958",
"telephone_number": "336-598-4697"
}
],
"practiceLocations": [
{
"address_1": "403 Crestview Ave SW",
"address_purpose": "LOCATION",
"city": "Wilson",
"state": "NC",
"postal_code": "278934505",
"country_code": "US",
"telephone_number": "252-237-0724",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DE LA CRUZ",
"first_name": "JAY EMMANUEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-08-07",
"last_updated": "2020-05-05",
"certification_date": "2020-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NC",
"license": "11511",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roxboro, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.