Provider Demographics
NPI:1447631767
Name:KRUSE, AMANDA (MBA, LAT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MBA, LAT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:SCHMALTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1681 COMMERCE DR.
Mailing Address - Street 2:
Mailing Address - City:NORTH MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56003
Mailing Address - Country:US
Mailing Address - Phone:507-625-8017
Mailing Address - Fax:507-625-2325
Practice Address - Street 1:1681 COMMERCE DR.
Practice Address - Street 2:
Practice Address - City:NORTH MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56003
Practice Address - Country:US
Practice Address - Phone:507-625-8017
Practice Address - Fax:507-625-2325
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer