Provider Demographics
NPI:1780962688
Name:KRAMER, STACY JO (MPT)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:JO
Last Name:KRAMER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 N ESTHER ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:NE
Mailing Address - Zip Code:68638-3029
Mailing Address - Country:US
Mailing Address - Phone:308-536-2488
Mailing Address - Fax:308-536-3226
Practice Address - Street 1:202 N ESTHER ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:NE
Practice Address - Zip Code:68638-3029
Practice Address - Country:US
Practice Address - Phone:308-536-2488
Practice Address - Fax:308-536-3226
Is Sole Proprietor?:No
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2192225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist