Provider Demographics
NPI:1720337892
Name:KRUK, ERICA MARIE (DPT)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:MARIE
Last Name:KRUK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:ERICA
Other - Middle Name:MARIE
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:420 E 120TH AVE
Mailing Address - Street 2:SUITE B-8
Mailing Address - City:NORTHGLENN
Mailing Address - State:CO
Mailing Address - Zip Code:80233-1127
Mailing Address - Country:US
Mailing Address - Phone:303-280-3838
Mailing Address - Fax:303-280-3837
Practice Address - Street 1:420 E 120TH AVE
Practice Address - Street 2:SUITE B-8
Practice Address - City:NORTHGLENN
Practice Address - State:CO
Practice Address - Zip Code:80233-1127
Practice Address - Country:US
Practice Address - Phone:303-280-3838
Practice Address - Fax:303-280-3837
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-05
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY006092225100000X
CO0012437225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist