Provider Demographics
NPI:1316164445
Name:KRUSE, BRADLEY MICHAEL (PT, DPT, ATC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:KRUSE
Suffix:
Gender:M
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3049 SPRING VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-1528
Mailing Address - Country:US
Mailing Address - Phone:563-513-4509
Mailing Address - Fax:
Practice Address - Street 1:1550 CLARKE DR
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-3117
Practice Address - Country:US
Practice Address - Phone:563-588-6403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02771225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist