Provider Demographics
NPI:1740941483
Name:KRUEGER, SAMANTHA JO
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JO
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1433
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-1433
Mailing Address - Country:US
Mailing Address - Phone:620-255-2133
Mailing Address - Fax:
Practice Address - Street 1:300 S AZTEC ST
Practice Address - Street 2:
Practice Address - City:MONTEZUMA
Practice Address - State:KS
Practice Address - Zip Code:67867-8811
Practice Address - Country:US
Practice Address - Phone:620-846-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02923225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant