Healthcare Provider Details

I. General information

NPI: 1194655886
Provider Name (Legal Business Name): MARLENE E KRAMER JR. PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 DOUGLAS ST
PETALUMA CA
94952-2503
US

IV. Provider business mailing address

329 E PENN ST
LONG BEACH NY
11561-4331
US

V. Phone/Fax

Practice location:
  • Phone: 707-763-6887
  • Fax:
Mailing address:
  • Phone: 516-589-5481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number015117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: