Provider Demographics
NPI:1235419243
Name:KRAMER, BRIAN HUGH (PT)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:HUGH
Last Name:KRAMER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1251 E DOROTHY LN
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-2106
Mailing Address - Country:US
Mailing Address - Phone:937-298-1111
Mailing Address - Fax:937-298-7210
Practice Address - Street 1:829 MCKINLEY AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:OH
Practice Address - Zip Code:45365-3356
Practice Address - Country:US
Practice Address - Phone:937-726-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOO5842172V00000X
OH005842172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker