Healthcare Provider Details

I. General information

NPI: 1861706418
Provider Name (Legal Business Name): BRIAN TIMOTHY KRATZ PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 09/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD SUITE 300
AUSTIN TX
78723-3077
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD SUITE 300
AUSTIN TX
78723-3077
US

V. Phone/Fax

Practice location:
  • Phone: 512-478-8116
  • Fax: 512-478-9368
Mailing address:
  • Phone: 512-478-8116
  • Fax: 512-478-9368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number1190039
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number1190039
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: