Provider Demographics
NPI:1598835803
Name:KRAMER, STEPHEN P (PT, ATC)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:P
Last Name:KRAMER
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 REPUBLIC AVE STE E
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-6863
Mailing Address - Country:US
Mailing Address - Phone:337-988-7777
Mailing Address - Fax:337-988-7720
Practice Address - Street 1:112 REPUBLIC AVE STE E
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6863
Practice Address - Country:US
Practice Address - Phone:337-988-7777
Practice Address - Fax:337-988-7720
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA01644225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1183041Medicaid
LA1183041Medicaid