Provider Demographics
NPI:1871514885
Name:SCHRAMM, GRANT J (PT)
Entity type:Individual
Prefix:
First Name:GRANT
Middle Name:J
Last Name:SCHRAMM
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 747
Mailing Address - Street 2:
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69103-0747
Mailing Address - Country:US
Mailing Address - Phone:308-534-0999
Mailing Address - Fax:308-534-7299
Practice Address - Street 1:120 WEST LEOTA STREET
Practice Address - Street 2:
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-6036
Practice Address - Country:US
Practice Address - Phone:308-534-0999
Practice Address - Fax:308-534-7299
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE908225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
39863OtherBCBS
650021727OtherRAILROAD MEDICARE
NE47084123332Medicaid
39863OtherBCBS
NE47084123332Medicaid