Provider Demographics
NPI:1740686419
Name:KREN, JOHN FREDERICK SR (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FREDERICK
Last Name:KREN
Suffix:SR
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 1:406 MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4087
Mailing Address - Country:US
Mailing Address - Phone:410-822-4613
Mailing Address - Fax:410-822-6534
Practice Address - Street 1:63A ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-9167
Practice Address - Country:US
Practice Address - Phone:302-537-7260
Practice Address - Fax:302-537-7293
Is Sole Proprietor?:No
Enumeration Date:2014-11-07
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001846225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE086513OtherMEDICARE
DE0000220726Medicaid