Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251G0304X | Physical Therapist - Geriatrics | ||
Y | 2251N0400X | Physical Therapist - Neurology | 05009194A | IN |
NPI | 1649698358 |
---|---|
Provider Name | Carol Krueger-Brophy |
First Address | West Lafayette, IN 47906-2186 |
Second Address | Lafayette, IN 47904-2134 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2014 |
Last Update Date | 31/03/2014 |