Provider Demographics
NPI:1598892796
Name:KREMER, PAUL J (PT)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:KREMER
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 1:339 SAIL BOAT RUN APT 2B
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-4272
Mailing Address - Country:US
Mailing Address - Phone:937-417-3714
Mailing Address - Fax:
Practice Address - Street 1:8051 WASHINGTON VILLAGE DR
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458
Practice Address - Country:US
Practice Address - Phone:937-291-3160
Practice Address - Fax:937-291-3159
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT011701225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108341Medicaid
OH000000190966OtherBCBS
OH000000190966OtherBCBS