Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist |
NPI | 1164518445 |
---|---|
Provider Name | Mr. Jerry W Kraiss |
First Address | Elkton, MD 21921-2013 |
Second Address | Baltimore, MD 21201-1524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 08/07/2007 |