Provider Demographics
NPI:1326544412
Name:KRUTSINGER, TRAVIS LEE (PTA)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:LEE
Last Name:KRUTSINGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15500 555TH ST
Mailing Address - Street 2:
Mailing Address - City:LUCAS
Mailing Address - State:IA
Mailing Address - Zip Code:50151-8473
Mailing Address - Country:US
Mailing Address - Phone:641-203-0936
Mailing Address - Fax:641-342-1219
Practice Address - Street 1:109 W MCLANE ST
Practice Address - Street 2:
Practice Address - City:OSCEOLA
Practice Address - State:IA
Practice Address - Zip Code:50213-1419
Practice Address - Country:US
Practice Address - Phone:641-342-1470
Practice Address - Fax:641-342-1219
Is Sole Proprietor?:No
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00581225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant