Provider Demographics
NPI:1013977412
Name:KRAFT, KIMBERLY G (PT CHT)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:G
Last Name:KRAFT
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8000 SR 64 E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-7703
Mailing Address - Country:US
Mailing Address - Phone:941-792-1404
Mailing Address - Fax:941-761-0712
Practice Address - Street 1:8000 SR 64 E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-7703
Practice Address - Country:US
Practice Address - Phone:941-792-1404
Practice Address - Fax:941-761-0712
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT40132225100000X
IN05010524A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQY639OtherMEDICARE
IN062110022OtherMEDICARE PTAN
IN201035780Medicaid