Provider Demographics
NPI:1508111493
Name:KRUS, KATIE MELISSA (DPT, LAT)
Entity Type:Individual
Prefix:DR
First Name:KATIE
Middle Name:MELISSA
Last Name:KRUS
Suffix:
Gender:F
Credentials:DPT, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1066 BIG BEND STATION DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63088-1430
Mailing Address - Country:US
Mailing Address - Phone:314-761-6790
Mailing Address - Fax:
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:SUITE 20
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:636-893-1360
Practice Address - Fax:636-893-1362
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012023549225100000X
MO20120216522255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer