Provider Demographics
NPI:1689046484
Name:KRANDA, THOMAS (PT, DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:KRANDA
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:KRANDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:1201 5TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554-5603
Mailing Address - Country:US
Mailing Address - Phone:701-527-7511
Mailing Address - Fax:
Practice Address - Street 1:1201 5TH AVE NE
Practice Address - Street 2:
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554-5603
Practice Address - Country:US
Practice Address - Phone:701-527-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-20
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1954225100000X
MO2015027893225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist