Basic Information
| Provider Information | |||||||||
| NPI: | 1609984244 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRUSE | ||||||||
| FirstName: | KRISTEN | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 PARK BLVD | ||||||||
| Address2: | SUITE LL80C | ||||||||
| City: | ITASCA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601433121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6302858007 | ||||||||
| FaxNumber: | 6302858017 | ||||||||
| Practice Location | |||||||||
| Address1: | 1440 W NORTH AVE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601601422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7088658600 | ||||||||
| FaxNumber: | 7087658661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.