Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 226300000X | Kinesiotherapist | 1128 | CA |
NPI | 1275574733 |
---|---|
Provider Name | Mrs. Michelle Renee Cramer |
First Address | Prescott, AZ 86301-5403 |
Second Address | Prescott, AZ 86313-5001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1128 | KT REGISTRY NUMBER (01) |