Provider Demographics
NPI:1528315371
Name:KRUEGER, MICHELLE CHRISTINE (PTA)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHRISTINE
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 1:2424 W GRAND RONDE PL
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2536
Mailing Address - Country:US
Mailing Address - Phone:509-929-6690
Mailing Address - Fax:
Practice Address - Street 1:1350 N GRANT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1355
Practice Address - Country:US
Practice Address - Phone:509-735-2014
Practice Address - Fax:509-735-3980
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP160292386225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant