Provider Demographics
NPI:1750785317
Name:KRUSE, DANIEL WILLIAM KALANI (PTA)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:WILLIAM KALANI
Last Name:KRUSE
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22503 62ND AVE W
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-2507
Mailing Address - Country:US
Mailing Address - Phone:425-877-0869
Mailing Address - Fax:
Practice Address - Street 1:6912 220TH ST SW
Practice Address - Street 2:200
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-2169
Practice Address - Country:US
Practice Address - Phone:425-672-2716
Practice Address - Fax:425-672-2720
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP1604398172081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine