Provider Demographics
NPI:1932708963
Name:KRUEGER, BETH ANNE (PTA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANNE
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5830 OAKWOOD DR APT 2B
Mailing Address - Street 2:
Mailing Address - City:LISLE
Mailing Address - State:IL
Mailing Address - Zip Code:60532-2960
Mailing Address - Country:US
Mailing Address - Phone:630-408-7992
Mailing Address - Fax:
Practice Address - Street 1:16W301 91ST ST
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-6368
Practice Address - Country:US
Practice Address - Phone:773-633-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL160.009063225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant