Provider Demographics
NPI:1467616458
Name:KROUT, DAVID ANDREW (PT)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ANDREW
Last Name:KROUT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 PROGRESS RD
Mailing Address - Street 2:
Mailing Address - City:ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-8800
Mailing Address - Country:US
Mailing Address - Phone:706-698-3000
Mailing Address - Fax:706-698-3001
Practice Address - Street 1:943 PROGRESS RD
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8800
Practice Address - Country:US
Practice Address - Phone:706-698-3000
Practice Address - Fax:706-698-3001
Is Sole Proprietor?:No
Enumeration Date:2008-07-18
Last Update Date:2020-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT14933225100000X
NCP11802225100000X
GAPT012290225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist