MEDICARE: MR. JEREMY SEAN KRUGER MSPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	004175	KY

General Provider Information

NPI Number	:	1326045360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JEREMY SEAN KRUGER MSPT

Provider Business Mailing Address
First Line	:	404 SHOPPERS DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1378
Country	:	US
Telephone Number	:	859-737-5333
Fax Number	:	859-737-0070

Provider Business Practice Location Address
First Line	:	404 SHOPPERS DR
Second Line	:
City	:	WINCHESTER
State	:	KY
Zip	:	40391-1378
Country	:	US
Telephone Number	:	859-737-5333
Fax Number	:	859-737-0070

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	02/25/2014

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