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General NPI Number Information
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NPI Number | 1538689716
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Entity Type | Individual
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Provider Name | JACOB GEORGE KRIEGBAUM DPT
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Gender | Male
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Dates
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Enumeration Date | 06/20/2017
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Last Update Date | 07/30/2024
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Provider Practice Location Address
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Address Line | UNIT 5115 BOX 48TH
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City | APO
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State | AE
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Zip | 09461-5115
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Country | US
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Telephone | 314-226-8307
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Fax |
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Provider Business Mailing Address
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Address Line | UNIT 5115 BOX 48TH
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City | APO
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State | AE
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Zip | 09461-5115
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Country | US
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Telephone | 314-226-8307
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT60745455
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License Number State | WA
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