Provider Demographics
NPI:1104818277
Name:KROEKER, BYRON L (PT)
Entity type:Individual
Prefix:MR
First Name:BYRON
Middle Name:L
Last Name:KROEKER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 23RD ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-2306
Mailing Address - Country:US
Mailing Address - Phone:661-327-4357
Mailing Address - Fax:661-327-2311
Practice Address - Street 1:200 CHINA GRADE LOOP
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93308-1735
Practice Address - Country:US
Practice Address - Phone:661-615-6150
Practice Address - Fax:661-615-6151
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19887225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PT198871OtherMEDICARE INDIVIDUAL PTAN
CAZZZ21295ZOtherMEDICARE GROUP PTAN
CAP00077627OtherRAILROAD MEDICARE PTAN
CAOPT198870Medicare ID - Type Unspecified