Provider Demographics
NPI:1609025162
Name:KRUG, RHONDA SUE (PTA)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:SUE
Last Name:KRUG
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CATLIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2012
Mailing Address - Country:US
Mailing Address - Phone:763-682-2202
Mailing Address - Fax:
Practice Address - Street 1:300 CATLIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BUFFALO
Practice Address - State:MN
Practice Address - Zip Code:55313-2012
Practice Address - Country:US
Practice Address - Phone:763-682-2202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA1057225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant