Healthcare Provider Details

I. General information

NPI: 1255040721
Provider Name (Legal Business Name): TIDD-KRAFFT OCCUPATIONAL AND PHYSICAL THERAPY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 115TH ST
LEAWOOD KS
66211-2684
US

IV. Provider business mailing address

101 E STATE ST
KENNETT SQUARE PA
19348-3109
US

V. Phone/Fax

Practice location:
  • Phone: 913-348-6362
  • Fax:
Mailing address:
  • Phone: 800-728-8808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARL ANTHONY SHROM
Title or Position: CEO
Credential:
Phone: 215-896-0422