Provider Demographics
NPI:1487636544
Name:KRUSE, COREY M (MPT)
Entity Type:Individual
Prefix:
First Name:COREY
Middle Name:M
Last Name:KRUSE
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COMPUTER DR W
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1622
Mailing Address - Country:US
Mailing Address - Phone:518-489-2524
Mailing Address - Fax:518-489-3167
Practice Address - Street 1:2 COMPUTER DR W
Practice Address - Street 2:SUITE 200
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1622
Practice Address - Country:US
Practice Address - Phone:518-489-2524
Practice Address - Fax:518-489-3167
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027088-1225100000X
NY027088225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02651201Medicaid
NYP00217544OtherRAILROAD MEDICARE
P00217544OtherMEDICARE RAILROAD
NYP00217544OtherRAILROAD MEDICARE
NY02651201Medicaid