Provider Demographics
NPI:1346312972
Name:KRUISE, AUTUMN LEIGH (PTA)
Entity Type:Individual
Prefix:MS
First Name:AUTUMN
Middle Name:LEIGH
Last Name:KRUISE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 BELLVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4003
Mailing Address - Country:US
Mailing Address - Phone:814-944-9759
Mailing Address - Fax:
Practice Address - Street 1:916 HICKORY ST
Practice Address - Street 2:
Practice Address - City:HOLLIDAYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16648-2248
Practice Address - Country:US
Practice Address - Phone:814-696-4537
Practice Address - Fax:814-696-4537
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE006955225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant