Provider Demographics
NPI:1952606568
Name:KRUEGER, KIM (PT)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:
Last Name:KRUEGER
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 1:427 S FORK DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-8042
Mailing Address - Country:US
Mailing Address - Phone:952-835-4512
Mailing Address - Fax:952-516-5655
Practice Address - Street 1:7815 3RD ST N
Practice Address - Street 2:SUITE 203
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5447
Practice Address - Country:US
Practice Address - Phone:952-835-1779
Practice Address - Fax:952-516-5655
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6067-24225100000X
MN8678225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist