Provider Demographics
NPI:1528138161
Name:KRUZEL, REBECCA JEAN (OPA-C)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JEAN
Last Name:KRUZEL
Suffix:
Gender:F
Credentials:OPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4461 COIT RD
Mailing Address - Street 2:STE 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0521
Mailing Address - Country:US
Mailing Address - Phone:972-335-8455
Mailing Address - Fax:972-335-7560
Practice Address - Street 1:4461 COIT RD
Practice Address - Street 2:STE 101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-0521
Practice Address - Country:US
Practice Address - Phone:972-335-8455
Practice Address - Fax:972-335-7560
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX903OtherOPA-C CERTIFICATE