Provider Demographics
NPI:1982767505
Name:KRAMER, WILFRIED JOHN (PT)
Entity Type:Individual
Prefix:
First Name:WILFRIED
Middle Name:JOHN
Last Name:KRAMER
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 1:312 PASADERA CT
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-7622
Mailing Address - Country:US
Mailing Address - Phone:831-372-2963
Mailing Address - Fax:
Practice Address - Street 1:550 CAMINO EL ESTERO
Practice Address - Street 2:STE 100
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3231
Practice Address - Country:US
Practice Address - Phone:831-372-2963
Practice Address - Fax:831-656-9179
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT8775225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00374181OtherMC RAILROAD PIN
CA00PT87750OtherBLUE SHIELD PIN NUMBER
CAPT8775OtherSTATE LICENSE
CA00PT87750OtherBLUE SHIELD PIN NUMBER