Provider Demographics
NPI:1255507042
Name:KRUEGER, BRIAN ARTHUR (PTA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:ARTHUR
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2933 W LAPHAM ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-1946
Mailing Address - Country:US
Mailing Address - Phone:414-645-3637
Mailing Address - Fax:
Practice Address - Street 1:2933 W LAPHAM ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-1946
Practice Address - Country:US
Practice Address - Phone:414-645-3637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1375-019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant