Provider Demographics
NPI:1376527671
Name:KRUMP, PETER (OTR/L)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KRUMP
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CONNETICUT AVENUE SOUTH
Mailing Address - Street 2:ST. CLOUD ORTHOPEDICS
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377
Mailing Address - Country:US
Mailing Address - Phone:320-202-5508
Mailing Address - Fax:320-257-5523
Practice Address - Street 1:1901 CONNETICUT AVENUE SOUTH
Practice Address - Street 2:ST. CLOUD ORTHOPEDICS
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-202-5508
Practice Address - Fax:320-257-5523
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNMN100734225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6403005OtherMEDICA PROVIDER ID
MN5G694KROtherBCBS PROVIDER ID
MN41163580956301B003OtherCHAMPUS
MNHP24510OtherHEALTHPARTNERS ID
MN150033OtherMAYO MANAGEMENT ID