MEDICARE: JENNIFER MARIE KROUSE PTA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225200000X	Physical Therapy Assistant	30123	FL

General Provider Information

NPI Number	:	1427828318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE KROUSE PTA

Provider Business Mailing Address
First Line	:	9921 62ND ST N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33782-3126
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4655 66TH ST N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-4827
Country	:	US
Telephone Number	:	727-546-4700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2024
Last Update Date	:	01/03/2024

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