MEDICARE: CARISSA KRAFT II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	2305202333	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2305202333	OTHER	VA	LICENSE #

General Provider Information

NPI Number	:	1538279021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA KRAFT II

Provider Business Mailing Address
First Line	:	10536 FALKIRK WAY
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20109-6488
Country	:	US
Telephone Number	:	301-431-3572
Fax Number	:

Provider Business Practice Location Address
First Line	:	5618 OX RD
Second Line	:	SUITE H
City	:	FAIRFAX STATION
State	:	VA
Zip	:	22039-1018
Country	:	US
Telephone Number	:	703-426-4949
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	08/27/2007

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Directions to “ CARISSA KRAFT II ” Practice Location

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