Provider Demographics
NPI:1154322824
Name:KRUG, REGINA (PT)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:KRUG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07657-1521
Mailing Address - Country:US
Mailing Address - Phone:201-945-2955
Mailing Address - Fax:201-945-4277
Practice Address - Street 1:663 GRAND AVE
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07657-1521
Practice Address - Country:US
Practice Address - Phone:201-945-2955
Practice Address - Fax:201-945-4277
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00137400225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist