Provider Demographics
NPI:1265431837
Name:KRAUSE, KEVIN WALTER (PT)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WALTER
Last Name:KRAUSE
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 1:1539 N BOUNDARY RD
Mailing Address - Street 2:
Mailing Address - City:BERNVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19506-8350
Mailing Address - Country:US
Mailing Address - Phone:610-488-0289
Mailing Address - Fax:
Practice Address - Street 1:1011 W PENN AVE
Practice Address - Street 2:
Practice Address - City:ROBESONIA
Practice Address - State:PA
Practice Address - Zip Code:19551-9550
Practice Address - Country:US
Practice Address - Phone:610-589-2263
Practice Address - Fax:610-589-2232
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT006670L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA474736QVSMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER