Provider Demographics
NPI:1912662909
Name:KRUKOWSKI, JANE ELIZABETH (PTA)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:KRUKOWSKI
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:BRIDGES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6028 IRON HORSE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76148-4015
Mailing Address - Country:US
Mailing Address - Phone:817-991-1641
Mailing Address - Fax:
Practice Address - Street 1:721 DUNAWAY LN
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-2605
Practice Address - Country:US
Practice Address - Phone:817-991-1641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2166268225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant