Provider Demographics
NPI:1497735443
Name:KREUSER, JEFFERY L (LPT)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:L
Last Name:KREUSER
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:279 S 17TH AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3001
Mailing Address - Country:US
Mailing Address - Phone:262-335-0514
Mailing Address - Fax:262-335-0514
Practice Address - Street 1:279 S 17TH AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3001
Practice Address - Country:US
Practice Address - Phone:262-335-0514
Practice Address - Fax:262-335-0514
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1848-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40121700Medicaid
WI40121700Medicaid