Provider Demographics
NPI:1770635534
Name:KREUGER, DIANE (CMT)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:KREUGER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14585 GRAND AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-5721
Mailing Address - Country:US
Mailing Address - Phone:952-898-5143
Mailing Address - Fax:
Practice Address - Street 1:14585 GRAND AVE STE 207
Practice Address - Street 2:
Practice Address - City:BURNSVILLE
Practice Address - State:MN
Practice Address - Zip Code:55306-5721
Practice Address - Country:US
Practice Address - Phone:952-898-5143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist