Provider Demographics
NPI:1427598648
Name:KRUEGER, ADAM (ATC,LAT,CSCS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:ATC,LAT,CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 WATTS RD APT 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-3700
Mailing Address - Country:US
Mailing Address - Phone:636-866-1214
Mailing Address - Fax:608-663-3405
Practice Address - Street 1:1000 EDGEWOOD COLLEGE DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1997
Practice Address - Country:US
Practice Address - Phone:608-663-3326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1769-392255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer