Provider Demographics
NPI:1942295498
Name:STROUP, JEREMY KENT (PT)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:KENT
Last Name:STROUP
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 1:310 PENN STREET
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648
Mailing Address - Country:US
Mailing Address - Phone:814-695-2923
Mailing Address - Fax:814-695-2924
Practice Address - Street 1:3200 FAIRWAY DR
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4458
Practice Address - Country:US
Practice Address - Phone:814-941-7708
Practice Address - Fax:814-941-7715
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2013-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011814L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA650021205OtherRRMEDICARE
PA920436OtherHIGHMARK
PA650021205OtherRRMEDICARE
PA920436OtherHIGHMARK