Provider Demographics
NPI:1538325956
Name:KRUEGER, CAROL A (LMT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1122
Mailing Address - Country:US
Mailing Address - Phone:606-862-9518
Mailing Address - Fax:606-862-9518
Practice Address - Street 1:911 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-1122
Practice Address - Country:US
Practice Address - Phone:606-862-9518
Practice Address - Fax:606-862-9518
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-2248225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist