Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 2338-19 | WI |
NPI | 1346614229 |
---|---|
Provider Name | Miranda Krueger |
First Address | Weston, WI 54476-4186 |
Second Address | Weston, WI 54476-4186 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2015 |
Last Update Date | 16/11/2015 |