Healthcare Provider Details

I. General information

NPI: 1023582756
Provider Name (Legal Business Name): CAITLYN KRUEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2019
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANCER PERFORMANCE CENTER 22ND ST
APO AA
98433
US

IV. Provider business mailing address

LANCER PERFORMANCE CENTER 22ND ST
TACOMA OH
98432
US

V. Phone/Fax

Practice location:
  • Phone: 253-966-1400
  • Fax:
Mailing address:
  • Phone: 609-658-2183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberA161567297
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: