Individual
CORISSA RAE KRUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 VIVIAN ST W, PARK RIVER, ND 58270-4540
(701) 284-4570
(701) 284-4581
Mailing address
12823 OAK GROVE DR, THIEF RIVER FALLS, MN 56701-8414
(218) 686-0188
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
2011
ND
Other
Enumeration date
05/25/2017
Last updated
05/25/2017
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