Provider Demographics
NPI:1639227291
Name:KRAEMER, MATTHEW TODD (PT)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:TODD
Last Name:KRAEMER
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 1:4440 N 36TH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3588
Mailing Address - Country:US
Mailing Address - Phone:602-956-4040
Mailing Address - Fax:602-956-4011
Practice Address - Street 1:1111 E MCDOWELL RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-839-8106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6533225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0461720OtherGROUP BCBS NUMBER
AZ2Z1695OtherHEALTH NET ID NUMBER
AZ610640800OtherGROUP OWCP NUMBER
AZZ104176Medicare PIN