Provider Demographics
NPI:1124544804
Name:KRUFAL, DEANN LYNN (ACT, LAT, BHS)
Entity Type:Individual
Prefix:
First Name:DEANN
Middle Name:LYNN
Last Name:KRUFAL
Suffix:
Gender:F
Credentials:ACT, LAT, BHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SCARLET OAK DR
Mailing Address - Street 2:
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2140
Mailing Address - Country:US
Mailing Address - Phone:636-579-1759
Mailing Address - Fax:
Practice Address - Street 1:1201 N SCENIC HWY
Practice Address - Street 2:
Practice Address - City:BABSON PARK
Practice Address - State:FL
Practice Address - Zip Code:33827-9751
Practice Address - Country:US
Practice Address - Phone:636-579-1759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017011142255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer