Provider Demographics
NPI:1093231029
Name:KRUGER, ALIVIA M
Entity Type:Individual
Prefix:
First Name:ALIVIA
Middle Name:M
Last Name:KRUGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8095 S 1100 W
Mailing Address - Street 2:
Mailing Address - City:FRANCESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47946-8270
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8095 S 1100 W
Practice Address - Street 2:
Practice Address - City:FRANCESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47946-8270
Practice Address - Country:US
Practice Address - Phone:219-204-9194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer