Provider Demographics
NPI:1639476930
Name:KRUSE, NICHOLE LEE (DPT)
Entity Type:Individual
Prefix:DR
First Name:NICHOLE
Middle Name:LEE
Last Name:KRUSE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14557 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE 500B
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-9243
Mailing Address - Country:US
Mailing Address - Phone:623-242-6908
Mailing Address - Fax:623-242-6909
Practice Address - Street 1:14557 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE 500B
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-242-6908
Practice Address - Fax:623-242-6909
Is Sole Proprietor?:No
Enumeration Date:2011-02-22
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ9253225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist