Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 619 | IL |
NPI | 1114011335 |
---|---|
Provider Name | Mr. George Henry Kramer |
First Address | Wheaton, IL 60187-6025 |
Second Address | Hines, IL 60141 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |