Provider Demographics
NPI:1083659676
Name:KRUTZIG, DONALD JAMES (MS, ATC)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:JAMES
Last Name:KRUTZIG
Suffix:
Gender:M
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14031 SOUTHBRIDGE FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-7845
Mailing Address - Country:US
Mailing Address - Phone:704-588-0430
Mailing Address - Fax:
Practice Address - Street 1:14031 SOUTHBRIDGE FOREST DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-7845
Practice Address - Country:US
Practice Address - Phone:704-588-0430
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-18
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11552255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer