Provider Demographics
NPI:1487215992
Name:KRUSE, BROOKE MORGAN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:MORGAN
Last Name:KRUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35444 S 530TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CREEK
Mailing Address - State:NE
Mailing Address - Zip Code:68663-2831
Mailing Address - Country:US
Mailing Address - Phone:308-548-8653
Mailing Address - Fax:
Practice Address - Street 1:4715 38TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-1622
Practice Address - Country:US
Practice Address - Phone:402-942-9260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1415225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant