Healthcare Provider Details

I. General information

NPI: 1467430793
Provider Name (Legal Business Name): JULIE L KREGER DPT, ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 129TH ST S
TACOMA WA
98444-5044
US

IV. Provider business mailing address

315 129TH ST S
TACOMA WA
98444-5044
US

V. Phone/Fax

Practice location:
  • Phone: 253-298-3838
  • Fax: 253-298-3017
Mailing address:
  • Phone: 253-298-3838
  • Fax: 253-298-3017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT00010004
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: