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Individual

MATTHEW TODD KRAEMER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.T.

Contact information

Practice address
1111 E MCDOWELL RD, PHOENIX, AZ 85006
(602) 839-8106
Mailing address
4440 N 36TH ST, SUITE 240, PHOENIX, AZ 85018-3588
(602) 956-4040
(602) 956-4011

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
6533
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
2Z1695
HEALTH NET ID NUMBER
AZ
01
610640800
GROUP OWCP NUMBER
AZ
01
AZ0461720
GROUP BCBS NUMBER
AZ
Enumeration date
01/08/2007
Last updated
08/02/2018
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