=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265288732
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WENDY KRAFT PTA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2024
-----------------------------------------------------
Last Update Date | 04/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 425 BUTTONWOOD ST
-----------------------------------------------------
City | WEST READING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19611-1101
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-269-1475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 GOUGLERSVILLE RD
-----------------------------------------------------
City | SINKING SPRING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19608-9256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-269-1475
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225200000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Assistant
-----------------------------------------------------
License Number | TEI000532
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------