MR. Richard Warren Kruckeberg, P.T., O.C.S., C.H.T.

NPI #1245362920 in Mattoon, Illinois

Provider Information

NPI Number: 1245362920
Entity Type: Individual
Name: MR. Richard Warren Kruckeberg, P.T., O.C.S., C.H.T.
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Physical Therapist
Credential: P.T., O.C.S., C.H.T.
Enumeration Date: Mar 9, 2007
Last Updated: Sep 19, 2011

Practice Location

Address: 100 PROFESSIONAL PLZ
City: Mattoon
State: Illinois
ZIP Code: 61938-9252
Phone: (217) 345-1245

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapist	225100000X	Primary

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