Provider Demographics
NPI:1467478321
Name:KREUTZER, JEFFREY S (PHD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:S
Last Name:KREUTZER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1200 E MARSHALL STREET
Practice Address - Street 2:PHYSICAL MEDICINE & REHAB
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0677
Practice Address - Country:US
Practice Address - Phone:804-828-0231
Practice Address - Fax:804-828-2378
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001170103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7767471Medicaid
VA7767471Medicaid