Provider Demographics
NPI:1306202775
Name:KRATZENBERG, KYLE WILLIAM (MS, ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:KYLE
Middle Name:WILLIAM
Last Name:KRATZENBERG
Suffix:
Gender:M
Credentials:MS, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14838 VANCE JACKSON RD
Mailing Address - Street 2:#0222
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3152
Mailing Address - Country:US
Mailing Address - Phone:254-458-1776
Mailing Address - Fax:
Practice Address - Street 1:1 UTSA CIR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1644
Practice Address - Country:US
Practice Address - Phone:210-527-3882
Practice Address - Fax:210-458-5118
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT62492255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer