MEDICARE: KRAFT PHYSICAL THERAPY LLC

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	174400000X	Specialist	PT12683	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y089A	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1316020118
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRAFT PHYSICAL THERAPY LLC

Provider Business Mailing Address
First Line	:	3089 TAMIAMI TRL.
Second Line	:	UNIT B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8052
Country	:	US
Telephone Number	:	941-661-6826
Fax Number	:

Provider Business Practice Location Address
First Line	:	3089 TAMIAMI TRAIL
Second Line	:	UNIT B
City	:	PORT CHARLOTTE
State	:	FL
Zip	:	33952-8052
Country	:	US
Telephone Number	:	941-661-6826
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST OWNER
Name	:	MRS. KRISTINA M. SCHWINT
Credential	:	P.T.
Telephone Number	:	941-661-6826

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	08/22/2020

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