Provider Demographics
NPI:1821014549
Name:KRUG, STEPHEN GERARD (PT)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:GERARD
Last Name:KRUG
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 1:117 MELLON AVE
Mailing Address - Street 2:
Mailing Address - City:PATTON
Mailing Address - State:PA
Mailing Address - Zip Code:16668-1721
Mailing Address - Country:US
Mailing Address - Phone:814-674-5943
Mailing Address - Fax:814-674-3716
Practice Address - Street 1:503 RAILROAD AVE
Practice Address - Street 2:PATTON PLAZA, SUITE 3
Practice Address - City:PATTON
Practice Address - State:PA
Practice Address - Zip Code:16668-1342
Practice Address - Country:US
Practice Address - Phone:814-674-2218
Practice Address - Fax:814-674-3716
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003879L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist