Provider Demographics
NPI:1790142024
Name:KLUEGER, ADAM (DPT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:KLUEGER
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 ATLANTIC AVE
Mailing Address - Street 2:400
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2218
Mailing Address - Country:US
Mailing Address - Phone:562-989-1700
Mailing Address - Fax:
Practice Address - Street 1:4401 ATLANTIC AVE
Practice Address - Street 2:400
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:562-989-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43303225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist