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General NPI Number Information
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NPI Number | 1508111493
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Entity Type | Individual
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Provider Name | KATIE MELISSA KRUS DPT, LAT
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Gender | Female
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Dates
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Enumeration Date | 07/17/2012
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Last Update Date | 07/08/2015
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Provider Practice Location Address
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Address Line | 633 EMERSON RD SUITE 20
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City | SAINT LOUIS
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State | MO
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Zip | 63141-6739
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Country | US
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Telephone | 636-893-1360
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Fax | 636-893-1362
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Provider Business Mailing Address
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Address Line | 1066 BIG BEND STATION DR
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City | MANCHESTER
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State | MO
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Zip | 63088-1430
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Country | US
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Telephone | 314-761-6790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2012023549
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2012021652
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License Number State | MO
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