Provider Demographics
NPI:1174953673
Name:CRUZ, AMY BETH (PT)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:BETH
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:BETH
Other - Last Name:KAUTSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10963 N 159TH LN
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-4604
Mailing Address - Country:US
Mailing Address - Phone:623-363-9923
Mailing Address - Fax:
Practice Address - Street 1:10474 W THUNDERBIRD BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3023
Practice Address - Country:US
Practice Address - Phone:623-972-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9138225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist