Basic Information
| Provider Information | |||||||||
| NPI: | 1588813000 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAL | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | JUSTIN | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 905 N CUSTER AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083982170 | ||||||||
| FaxNumber: | 3083985232 | ||||||||
| Practice Location | |||||||||
| Address1: | 905 N CUSTER AVE | ||||||||
| Address2: | |||||||||
| City: | GRAND ISLAND | ||||||||
| State: | NE | ||||||||
| PostalCode: | 688034304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3083982170 | ||||||||
| FaxNumber: | 3083985232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2008 | ||||||||
| LastUpdateDate: | 12/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2388 | NE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.