Provider Demographics
NPI:1588355960
Name:KRUEGER, MICHAELA ABIGAIL (ASSOCIATES DEGREE)
Entity type:Individual
Prefix:MISS
First Name:MICHAELA
Middle Name:ABIGAIL
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:ASSOCIATES DEGREE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 MIDDLE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:OHIOPYLE
Mailing Address - State:PA
Mailing Address - Zip Code:15470
Mailing Address - Country:US
Mailing Address - Phone:724-802-2941
Mailing Address - Fax:
Practice Address - Street 1:156 MIDDLE RIDGE RD
Practice Address - Street 2:
Practice Address - City:OHIOPYLE
Practice Address - State:PA
Practice Address - Zip Code:15470
Practice Address - Country:US
Practice Address - Phone:724-802-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE012968225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant