Provider Demographics
NPI:1487080875
Name:KRONLAGE, STEPHANIE JO (PTA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JO
Last Name:KRONLAGE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1174 IOWA DR
Mailing Address - Street 2:
Mailing Address - City:AMANA
Mailing Address - State:IA
Mailing Address - Zip Code:52203-7600
Mailing Address - Country:US
Mailing Address - Phone:319-721-4579
Mailing Address - Fax:
Practice Address - Street 1:1174 IOWA DR
Practice Address - Street 2:
Practice Address - City:AMANA
Practice Address - State:IA
Practice Address - Zip Code:52203-7600
Practice Address - Country:US
Practice Address - Phone:319-721-4579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01121225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant