Provider Demographics
NPI:1235258732
Name:KRUTHOFF, BRET ALAN (PT)
Entity Type:Individual
Prefix:
First Name:BRET
Middle Name:ALAN
Last Name:KRUTHOFF
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CHARLES CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50616-3468
Mailing Address - Country:US
Mailing Address - Phone:641-228-6344
Mailing Address - Fax:641-257-4339
Practice Address - Street 1:800 11TH ST
Practice Address - Street 2:
Practice Address - City:CHARLES CITY
Practice Address - State:IA
Practice Address - Zip Code:50616-3468
Practice Address - Country:US
Practice Address - Phone:641-228-6344
Practice Address - Fax:641-257-4339
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01857225100000X
IA000931227800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered227800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Certified