Provider Demographics
NPI:1508026501
Name:KRUSE, JEFFREY R (LMP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:R
Last Name:KRUSE
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 N SULLIVAN RD STE 21
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99037-8528
Mailing Address - Country:US
Mailing Address - Phone:509-926-7789
Mailing Address - Fax:509-926-7576
Practice Address - Street 1:618 N SULLIVAN RD STE 21
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037-8528
Practice Address - Country:US
Practice Address - Phone:509-926-7789
Practice Address - Fax:509-926-7576
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00022836225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist