Healthcare Provider Details

I. General information

NPI: 1134602634
Provider Name (Legal Business Name): TROY JONATHAN KRAFT PT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 01/14/2022
Certification Date: 01/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 W WARD RD STE 206
DUNKIRK MD
20754-3047
US

IV. Provider business mailing address

110 HOSPITAL RD STE 201
PRINCE FREDERICK MD
20678-4045
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-3440
  • Fax: 301-327-5374
Mailing address:
  • Phone: 410-535-1343
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA01809700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number28003
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: