Healthcare Provider Details

I. General information

NPI: 1841263829
Provider Name (Legal Business Name): CARL RAYMOND CRAMER ED.D., RKT, ATC, LAT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 01/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11300 N.E. SECOND AVE .BARRY UNIVERSITY ATHLETIC TRAININING
MIAMI SHORES FL
33161-6695
US

IV. Provider business mailing address

17916 SW 29TH ST
MIRAMAR FL
33029-5155
US

V. Phone/Fax

Practice location:
  • Phone: 305-899-3497
  • Fax: 305-899-4809
Mailing address:
  • Phone: 305-899-3497
  • Fax: 305-899-4809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAL 109
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: