Provider Demographics
NPI:1528499597
Name:JAKUBEK, KRAMER (PT, DPT, CSCS)
Entity type:Individual
Prefix:
First Name:KRAMER
Middle Name:
Last Name:JAKUBEK
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 INDUSTRIAL AVE STE 190
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-7904
Mailing Address - Country:US
Mailing Address - Phone:802-489-6245
Mailing Address - Fax:802-876-7096
Practice Address - Street 1:426 INDUSTRIAL AVE STE 190
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-7904
Practice Address - Country:US
Practice Address - Phone:802-860-4360
Practice Address - Fax:802-488-3160
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2020-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA015278002251X0800X
VT0400134115225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT6702569Medicaid