Bradley Davis Kruger, PT
Physical Therapist in Hayden, ID. Individual provider (NPI-1).
NPI number1497315253
StatusActive
Last updated in NPPESJun 14, 2019
Details
- NPI
- 1497315253
- Entity type
- Individual (NPI-1)
- Name
- Bradley Davis Kruger
- Credential
- PT
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Jun 14, 2019
- Last updated
- Jun 14, 2019
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - PHYSICAL THERAPIST IN PRIVATE PRACTICE
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 225100000X | Physical Therapist | PT-6167 | ID | Yes |
Practice location
1172 W Hayden AveHayden, ID 83835-8700
Phone 208-762-3332 · Fax 208-762-4268
Mailing address
1917 N Lakewood DrCoeur D Alene, ID 83814-2634
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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