Provider Demographics
NPI:1467842690
Name:KRUEGER, NEAL
Entity Type:Individual
Prefix:
First Name:NEAL
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 BELLERIVE DR
Mailing Address - Street 2:APT 47
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-8808
Mailing Address - Country:US
Mailing Address - Phone:314-808-4054
Mailing Address - Fax:
Practice Address - Street 1:2100 BELLERIVE DR
Practice Address - Street 2:APT 47
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8808
Practice Address - Country:US
Practice Address - Phone:314-808-4054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60493872225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist