Active NPI
Jessica Krueger
- Physical Therapy Assistant
- Kenosha, WI
National Provider Identifier
1255817318
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2641
- Practice address
- 5024 Green Bay Rd
Kenosha, WI 53144-1702 - Phone
- (262) 925-0200
- Fax
- (262) 925-8846
- NPI assigned
- Jul 12, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2641 | WI | Primary |
Addresses
Primary practice location
5024 Green Bay Rd
Kenosha, WI 53144-1702
Mailing address
1300 S Green Bay Rd Ste 205
Mount Pleasant, WI 53406-4469
Phone (262) 898-3930
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2641 | WI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1531353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1531353600000",
"number": "1255817318",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1300 S GREEN BAY RD STE 205",
"city": "MOUNT PLEASANT",
"state": "WI",
"postal_code": "534064469",
"telephone_number": "262-898-3930",
"fax_number": "262-898-3933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5024 GREEN BAY RD",
"city": "KENOSHA",
"state": "WI",
"postal_code": "531441702",
"telephone_number": "262-925-0200",
"fax_number": "262-925-8846"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "JESSICA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-07-12",
"last_updated": "2018-07-12",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "WI",
"license": "2641",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kenosha, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.