Provider Demographics
NPI:1679718167
Name:BAUTISTA, LORNA CRUZ (PT)
Entity type:Individual
Prefix:MRS
First Name:LORNA
Middle Name:CRUZ
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3290 N RIDGE RD
Mailing Address - Street 2:SUITE 290
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:720-448-3687
Mailing Address - Fax:
Practice Address - Street 1:3290 N RIDGE RD
Practice Address - Street 2:SUITE 290
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3655
Practice Address - Country:US
Practice Address - Phone:720-448-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10085225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist