MEDICARE: MRS. ANN SIMONICH KRAMER DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	0012604	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010160514	OTHER	ID	REGENCE BLUESHIELD
2	T9333	OTHER	ID	BLUE CROSS

General Provider Information

NPI Number	:	1457688335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANN SIMONICH KRAMER DPT

Provider Business Mailing Address
First Line	:	PO BOX 764
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-0764
Country	:	US
Telephone Number	:	208-819-3142
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 BRIGGS ST
Second Line	:
City	:	ERIE
State	:	CO
Zip	:	80516-5022
Country	:	US
Telephone Number	:	303-900-7798
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/12/2009
Last Update Date	:	10/22/2021

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