Active NPI
Miranda Krueger, PTA
- Geriatric Physical Therapist
- Weston, WI
National Provider Identifier
1346614229
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Physical Therapist
- License
- 2338-19
- Practice address
- 4810 Barbican Ave
Weston, WI 54476-4186 - Phone
- (715) 393-0400
- Fax
- (715) 393-0938
- NPI assigned
- Nov 16, 2015
- 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 |
|---|---|---|---|---|
| Geriatric Physical Therapist | 2251G0304X | 2338-19 | WI | Primary |
Addresses
Primary practice location
4810 Barbican Ave
Weston, WI 54476-4186
Mailing address
4810 Barbican Ave
Weston, WI 54476-4186
Phone (715) 393-0400
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 |
|---|---|---|---|
| 2338-19 | WI | MD | Geriatric Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447632000000",
"number": "1346614229",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4810 BARBICAN AVE",
"city": "WESTON",
"state": "WI",
"postal_code": "544764186",
"telephone_number": "715-393-0400",
"fax_number": "715-393-0938"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4810 BARBICAN AVE",
"city": "WESTON",
"state": "WI",
"postal_code": "544764186",
"telephone_number": "715-393-0400",
"fax_number": "715-393-0938"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUEGER",
"first_name": "MIRANDA",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-11-16",
"last_updated": "2015-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "2251G0304X",
"taxonomy_group": "",
"desc": "Physical Therapist, Geriatrics",
"state": "WI",
"license": "2338-19",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Weston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.