Provider Demographics
NPI:1821635780
Name:KRAUSE, CINDY MARIE (PTA)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:MARIE
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 1:7799 BRISTOL PARK DR UNIT 2NW
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-1043
Mailing Address - Country:US
Mailing Address - Phone:708-269-9516
Mailing Address - Fax:
Practice Address - Street 1:7799 BRISTOL PARK DR UNIT 2NW
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-1043
Practice Address - Country:US
Practice Address - Phone:708-269-9516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.006853225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant