Provider Demographics
NPI:1154678704
Name:KRAMER, BRENT (PTA)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:KRAMER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:S8050 WILL KUMLIN RD
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:WI
Mailing Address - Zip Code:54624-8643
Mailing Address - Country:US
Mailing Address - Phone:608-648-3670
Mailing Address - Fax:
Practice Address - Street 1:S8050 WILL KUMLIN RD
Practice Address - Street 2:
Practice Address - City:DE SOTO
Practice Address - State:WI
Practice Address - Zip Code:54624-8643
Practice Address - Country:US
Practice Address - Phone:608-648-3670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1903-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant