Provider Demographics
NPI:1801095146
Name:KROULIK, JASON DONALD (DPT)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:DONALD
Last Name:KROULIK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:33200 W 14 MILE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3563
Mailing Address - Country:US
Mailing Address - Phone:248-538-7607
Mailing Address - Fax:248-538-7623
Practice Address - Street 1:23852 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-1829
Practice Address - Country:US
Practice Address - Phone:313-565-4222
Practice Address - Fax:313-565-8703
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501013385225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist