Healthcare Provider Details

I. General information

NPI: 1831719236
Provider Name (Legal Business Name): CHERYL LEE KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2020
Last Update Date: 04/26/2020
Certification Date: 04/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N GLEBE RD STE 410
ARLINGTON VA
22201-5931
US

IV. Provider business mailing address

2600 CRYSTAL DR APT 1314
ARLINGTON VA
22202-3576
US

V. Phone/Fax

Practice location:
  • Phone: 571-414-6930
  • Fax:
Mailing address:
  • Phone: 703-338-8227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number2306604497
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: