Provider Demographics
NPI:1962854588
Name:KREMER, LOGAN (ATC)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:KREMER
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5537 IDLEWILD RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-9797
Mailing Address - Country:US
Mailing Address - Phone:859-486-0166
Mailing Address - Fax:
Practice Address - Street 1:5537 IDLEWILD RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-9797
Practice Address - Country:US
Practice Address - Phone:859-486-0166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT13172255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer