Basic Information
| Provider Information | |||||||||
| NPI: | 1912271503 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | JACKIE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 463 OHIO PIKE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452553721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132474340 | ||||||||
| FaxNumber: | 5132474360 | ||||||||
| Practice Location | |||||||||
| Address1: | 463 OHIO PIKE | ||||||||
| Address2: | SUITE 203 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452553721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132474340 | ||||||||
| FaxNumber: | 5132474360 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/29/2012 | ||||||||
| LastUpdateDate: | 02/29/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT-012780 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.