Provider Demographics
NPI:1669852299
Name:KRAUSE, DEBORAH JOAN (PTA)
Entity Type:Individual
Prefix:MS
First Name:DEBORAH
Middle Name:JOAN
Last Name:KRAUSE
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 1:1615 ELM ST.
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360
Mailing Address - Country:US
Mailing Address - Phone:219-873-5656
Mailing Address - Fax:
Practice Address - Street 1:780 DICKINSON RD.
Practice Address - Street 2:ADDISON POINTE HEALTH & REHAB CENTER
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304
Practice Address - Country:US
Practice Address - Phone:219-921-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06003929A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant