Healthcare Provider Details

I. General information

NPI: 1912023615
Provider Name (Legal Business Name): JEAN M KRAMER PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 BOSC CT
TELFORD PA
18969-2178
US

IV. Provider business mailing address

153 BOSC CT.
TELFORD PA
18969
US

V. Phone/Fax

Practice location:
  • Phone: 215-353-0683
  • Fax:
Mailing address:
  • Phone: 215-353-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberTE002617L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: