Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 8378 | MN |
NPI | 1023462157 |
---|---|
Provider Name | Mr. Miles Patrick Krueger |
First Address | Brainerd, MN 56401-4441 |
Second Address | Brainerd, MN 56401-4441 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2016 |
Last Update Date | 14/04/2016 |