Provider Demographics
NPI:1669589628
Name:KRAEMER, TERRY L (LMT)
Entity type:Individual
Prefix:MRS
First Name:TERRY
Middle Name:L
Last Name:KRAEMER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12030 US HWY 98 N
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33809
Mailing Address - Country:US
Mailing Address - Phone:863-858-4802
Mailing Address - Fax:863-858-4802
Practice Address - Street 1:12030 US HWY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809
Practice Address - Country:US
Practice Address - Phone:863-858-4802
Practice Address - Fax:863-858-4802
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA0007327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC5002OtherBLUE CROSS BLUE SHIELD