MEDICARE: REGINA KRUG P.T.

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	225100000X	Physical Therapist	40QA00137400	NJ

General Provider Information

NPI Number	:	1154322824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REGINA KRUG P.T.

Provider Business Mailing Address
First Line	:	663 GRAND AVE
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1521
Country	:	US
Telephone Number	:	201-945-2955
Fax Number	:	201-945-4277

Provider Business Practice Location Address
First Line	:	663 GRAND AVE
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1521
Country	:	US
Telephone Number	:	201-945-2955
Fax Number	:	201-945-4277

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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