Provider Demographics
NPI:1235995036
Name:KRAUSE, MATTHEW C (ATC)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:C
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14809 FARNHAM WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2618
Mailing Address - Country:US
Mailing Address - Phone:941-737-9935
Mailing Address - Fax:
Practice Address - Street 1:14809 FARNHAM WAY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2618
Practice Address - Country:US
Practice Address - Phone:941-737-9935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL54882255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer