Provider Demographics
NPI:1407748411
Name:KRUEGER, LILLIAN J (PTA)
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:J
Last Name:KRUEGER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5139 COUNTY ROAD 61
Mailing Address - Street 2:
Mailing Address - City:KEENESBURG
Mailing Address - State:CO
Mailing Address - Zip Code:80643-8730
Mailing Address - Country:US
Mailing Address - Phone:307-340-2319
Mailing Address - Fax:
Practice Address - Street 1:1093 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-2252
Practice Address - Country:US
Practice Address - Phone:303-655-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0015696225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant