Provider Demographics
NPI:1528679990
Name:CRUSE, STEVEN MICHAEL
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MICHAEL
Last Name:CRUSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 RAILROAD ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH FORK
Mailing Address - State:PA
Mailing Address - Zip Code:15956-1237
Mailing Address - Country:US
Mailing Address - Phone:814-288-9676
Mailing Address - Fax:
Practice Address - Street 1:207 OTTAWA ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15904-2337
Practice Address - Country:US
Practice Address - Phone:814-266-8621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012103225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant