Healthcare Provider Details

I. General information

NPI: 1528499597
Provider Name (Legal Business Name): KRAMER JAKUBEK PT, DPT, CSCS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 06/18/2020
Certification Date: 06/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 INDUSTRIAL AVE STE 190
WILLISTON VT
05495-7904
US

IV. Provider business mailing address

426 INDUSTRIAL AVE STE 190
WILLISTON VT
05495-7904
US

V. Phone/Fax

Practice location:
  • Phone: 802-860-4360
  • Fax: 802-488-3160
Mailing address:
  • Phone: 802-489-6245
  • Fax: 802-876-7096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0400134115
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number40QA01527800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: