Provider Demographics
NPI:1609312081
Name:KRUSE, COLIN
Entity type:Individual
Prefix:
First Name:COLIN
Middle Name:
Last Name:KRUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 COLLEGE DR STE C
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-1546
Mailing Address - Country:US
Mailing Address - Phone:725-254-1251
Mailing Address - Fax:725-254-1252
Practice Address - Street 1:555 COLLEGE DR STE C
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-1546
Practice Address - Country:US
Practice Address - Phone:725-254-1251
Practice Address - Fax:725-254-1252
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2024-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-32298225100000X
WAPT60700019225100000X
NV4132225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist