Provider Demographics
NPI:1417431776
Name:KRAUS, MARIANNE ADELE (DPT)
Entity Type:Individual
Prefix:
First Name:MARIANNE
Middle Name:ADELE
Last Name:KRAUS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 JOHNSON STREET RD
Mailing Address - Street 2:
Mailing Address - City:KEOKUK
Mailing Address - State:IA
Mailing Address - Zip Code:52632-9744
Mailing Address - Country:US
Mailing Address - Phone:641-660-4602
Mailing Address - Fax:
Practice Address - Street 1:1150 6TH AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:WI
Practice Address - Zip Code:54829-9103
Practice Address - Country:US
Practice Address - Phone:641-660-4602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14456-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist