Provider Demographics
NPI:1144248436
Name:KRUEGER, NANCY ASTA (PT)
Entity type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:ASTA
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6011
Mailing Address - Country:US
Mailing Address - Phone:619-444-6113
Mailing Address - Fax:619-444-8205
Practice Address - Street 1:590 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6011
Practice Address - Country:US
Practice Address - Phone:619-444-6113
Practice Address - Fax:619-444-8205
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT5391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT5391AMedicare ID - Type Unspecified