Provider Demographics
NPI:1114933280
Name:CRAFT, NICOLE LAYNE (MSPT)
Entity Type:Individual
Prefix:MISS
First Name:NICOLE
Middle Name:LAYNE
Last Name:CRAFT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 WOOD HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-2007
Mailing Address - Country:US
Mailing Address - Phone:540-529-4103
Mailing Address - Fax:
Practice Address - Street 1:3939 DAUGHTERY ROAD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-1989
Practice Address - Country:US
Practice Address - Phone:540-380-2685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204431225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist