Provider Demographics
NPI:1588813000
Name:KRAL, CHARLES JUSTIN (DPT)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:JUSTIN
Last Name:KRAL
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 N CUSTER AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-4304
Mailing Address - Country:US
Mailing Address - Phone:308-398-2170
Mailing Address - Fax:308-398-5232
Practice Address - Street 1:905 N CUSTER AVE
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-4304
Practice Address - Country:US
Practice Address - Phone:308-398-2170
Practice Address - Fax:308-398-5232
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist