MEDICARE: MCKAYLA ANN KRAFT PT, DPT

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	12982	MN
2	225100000X	Physical Therapist	2787	ND
3	225100000X	Physical Therapist	P21977	NC

General Provider Information

NPI Number	:	1700604782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MCKAYLA ANN KRAFT PT, DPT

Provider Business Mailing Address
First Line	:	1000 ANNE ST NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5109
Country	:	US
Telephone Number	:	218-751-0220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 ANNE ST NW
Second Line	:
City	:	BEMIDJI
State	:	MN
Zip	:	56601-5109
Country	:	US
Telephone Number	:	218-751-0220
Fax Number	:

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

Provider Enumeration Date	:	09/30/2024
Last Update Date	:	09/30/2024

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