Provider Demographics
NPI:1306345376
Name:CRAMER, GREG ELDON
Entity type:Individual
Prefix:
First Name:GREG
Middle Name:ELDON
Last Name:CRAMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N MONROE
Mailing Address - Street 2:
Mailing Address - City:SEDGWICK
Mailing Address - State:KS
Mailing Address - Zip Code:67204
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:710 N MONROE
Practice Address - Street 2:
Practice Address - City:SEDGWICK
Practice Address - State:KS
Practice Address - Zip Code:67135
Practice Address - Country:US
Practice Address - Phone:316-772-5185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-02510225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000OtherNON