MEDICARE: NOAH KRAMER

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	225200000X	Physical Therapy Assistant	1363	NE

General Provider Information

NPI Number	:	1841723087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NOAH KRAMER

Provider Business Mailing Address
First Line	:	663 FAIDLEY PL APT 3
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-3476
Country	:	US
Telephone Number	:	402-649-9114
Fax Number	:

Provider Business Practice Location Address
First Line	:	663 FAIDLEY PL APT 3
Second Line	:
City	:	GRAND ISLAND
State	:	NE
Zip	:	68803-3476
Country	:	US
Telephone Number	:	402-649-9114
Fax Number	:

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

Provider Enumeration Date	:	04/05/2017
Last Update Date	:	04/05/2017

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