Healthcare Provider Details

I. General information

NPI: 1750574117
Provider Name (Legal Business Name): ERIC STEPHEN KRUGER DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8495 161ST AVE NE
REDMOND WA
98052-3805
US

IV. Provider business mailing address

8495 161ST AVE NE
REDMOND WA
98052-3805
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-3001
  • Fax:
Mailing address:
  • Phone: 406-544-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00010684
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: