Healthcare Provider Details

I. General information

NPI: 1942413141
Provider Name (Legal Business Name): JANE ANN KROGMEIER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ANN KRUSE P.T.

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 LANGWORTHY ST
DUBUQUE IA
52001-7313
US

IV. Provider business mailing address

1500 ASSOCIATES DR
DUBUQUE IA
52002-2201
US

V. Phone/Fax

Practice location:
  • Phone: 563-584-3450
  • Fax: 563-584-3171
Mailing address:
  • Phone: 563-584-4100
  • Fax: 563-584-4110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number061411
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: