Provider Demographics
NPI:1871121525
Name:KRUTEL, VINCENT MICHAEL
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:MICHAEL
Last Name:KRUTEL
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 1:33 NORTH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:TALLMADGE
Mailing Address - State:OH
Mailing Address - Zip Code:44278-1900
Mailing Address - Country:US
Mailing Address - Phone:330-344-3019
Mailing Address - Fax:
Practice Address - Street 1:33 NORTH AVE STE 204
Practice Address - Street 2:
Practice Address - City:TALLMADGE
Practice Address - State:OH
Practice Address - Zip Code:44278-1900
Practice Address - Country:US
Practice Address - Phone:330-344-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002812225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist