Provider Demographics
NPI:1497838445
Name:KRAUSE, PHILIP C (PT OCS)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:C
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 SOUTH ROCHESTER ROAD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307
Mailing Address - Country:US
Mailing Address - Phone:248-601-9207
Mailing Address - Fax:248-650-8670
Practice Address - Street 1:3009 SOUTH BALDWIN ROAD
Practice Address - Street 2:
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359
Practice Address - Country:US
Practice Address - Phone:248-393-7707
Practice Address - Fax:248-373-7708
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501002005225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5870183OtherAETNA
ON26160Medicare ID - Type Unspecified