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General NPI Number Information
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NPI Number | 1356619183
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Entity Type | Individual
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Provider Name | MARLENE K KRUEGER PTA
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Gender | Female
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Dates
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Enumeration Date | 12/07/2011
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 2448 S 102ND ST SUITE 340
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City | MILWAUKEE
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State | WI
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Zip | 53227-2466
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Country | US
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Telephone | 414-329-3500
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Fax |
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Provider Business Mailing Address
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Address Line | 1418 LINDEN AVE
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City | JANESVILLE
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State | WI
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Zip | 53548-2831
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Country | US
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Telephone | 608-756-3406
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 413-19
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160.002613
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License Number State | IL
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