Provider Demographics
NPI:1568150647
Name:KRUGER, MELINDA ANN (LMT;LE)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:ANN
Last Name:KRUGER
Suffix:
Gender:F
Credentials:LMT;LE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3314 PALMETTO PALM DR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552-4205
Mailing Address - Country:US
Mailing Address - Phone:956-454-1231
Mailing Address - Fax:
Practice Address - Street 1:1000 CAMELOT DR STE A
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8423
Practice Address - Country:US
Practice Address - Phone:956-367-6254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT119519225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist