Provider Demographics
NPI:1124148242
Name:KRUEGER, DORIS LOUISE (PT)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:LOUISE
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 1:86081 542ND AVE
Mailing Address - Street 2:
Mailing Address - City:OSMOND
Mailing Address - State:NE
Mailing Address - Zip Code:68765-5076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:86081 542ND AVE
Practice Address - Street 2:
Practice Address - City:OSMOND
Practice Address - State:NE
Practice Address - Zip Code:68765-5076
Practice Address - Country:US
Practice Address - Phone:402-582-4576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist