Provider Demographics
NPI:1811572746
Name:PRATER, KEVIN DONALD
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:DONALD
Last Name:PRATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2041 N 3RD ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-7307
Mailing Address - Country:US
Mailing Address - Phone:214-724-6281
Mailing Address - Fax:
Practice Address - Street 1:1502 13TH AVE W STE 101
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801-3825
Practice Address - Country:US
Practice Address - Phone:701-651-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1271642225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist