Provider Demographics
NPI:1639508625
Name:KRUEGER, KYLIE (PTA)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:KYLIE
Other - Middle Name:
Other - Last Name:HEINZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PTA
Mailing Address - Street 1:4605 VALDRES SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WI
Mailing Address - Zip Code:54476-4189
Mailing Address - Country:US
Mailing Address - Phone:715-393-0400
Mailing Address - Fax:715-393-0435
Practice Address - Street 1:4605 VALDRES SPRINGS CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WI
Practice Address - Zip Code:54476-4189
Practice Address - Country:US
Practice Address - Phone:715-393-0400
Practice Address - Fax:715-393-0435
Is Sole Proprietor?:No
Enumeration Date:2013-11-11
Last Update Date:2013-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2069-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant