Provider Demographics
NPI:1063892099
Name:TOM KRUSE PHYSICAL THERAPY PC
Entity type:Organization
Organization Name:TOM KRUSE PHYSICAL THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:402-413-6549
Mailing Address - Street 1:8055 O ST
Mailing Address - Street 2:SUITE S103
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2564
Mailing Address - Country:US
Mailing Address - Phone:402-413-6549
Mailing Address - Fax:
Practice Address - Street 1:8055 O ST
Practice Address - Street 2:SUITE S103
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2564
Practice Address - Country:US
Practice Address - Phone:402-413-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1987261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy