Provider Demographics
NPI:1669021333
Name:KRAUSE, DANIEL (PT)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 N WAKEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2624
Mailing Address - Country:US
Mailing Address - Phone:414-852-8601
Mailing Address - Fax:
Practice Address - Street 1:8100 INNOVATION PARK DR STE LL20
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4870
Practice Address - Country:US
Practice Address - Phone:571-472-0490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305213186225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist