Provider Demographics
NPI:1831141530
Name:KRUSENKLAUS, JOHN K (PT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:KRUSENKLAUS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 52268
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37950-2268
Mailing Address - Country:US
Mailing Address - Phone:865-584-1054
Mailing Address - Fax:865-588-8350
Practice Address - Street 1:1120 E WEISGARBER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-2685
Practice Address - Country:US
Practice Address - Phone:865-584-1054
Practice Address - Fax:865-588-8350
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2879225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist