Provider Demographics
NPI:1982803425
Name:CRUSE, JESSICA AARON (PTA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:AARON
Last Name:CRUSE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 COUNTRY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-1166
Mailing Address - Country:US
Mailing Address - Phone:270-465-3506
Mailing Address - Fax:
Practice Address - Street 1:1980 OLD GREENSBURG RD
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-2536
Practice Address - Country:US
Practice Address - Phone:270-465-3506
Practice Address - Fax:270-789-4010
Is Sole Proprietor?:No
Enumeration Date:2007-07-14
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYA01741225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1457424160Medicaid