Provider Demographics
NPI:1932309192
Name:KRUGER, EMILY FERN (PT)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FERN
Last Name:KRUGER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2369 CORAL AVE NE
Mailing Address - Street 2:APT C
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97305-4215
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10220 SW GREENBURG RD
Practice Address - Street 2:LINCOLN CENTER 3, SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5503
Practice Address - Country:US
Practice Address - Phone:503-570-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4117225100000X
NE1973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist