Provider Demographics
NPI:1245571009
Name:CRAMER, BRIAN MATTHEW (MS, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:CRAMER
Suffix:
Gender:M
Credentials:MS, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4507 GOLDEN HINDE WAY
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6956
Mailing Address - Country:US
Mailing Address - Phone:317-376-5258
Mailing Address - Fax:
Practice Address - Street 1:14535A HAZEL DELL PKWY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-9401
Practice Address - Country:US
Practice Address - Phone:317-705-4392
Practice Address - Fax:317-705-4391
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN36001571A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer