Provider Demographics
NPI:1013977412
Name:KRAFT, KIMBERLY G (PT CHT)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:G
Last Name:KRAFT
Suffix:
Gender:F
Credentials:PT CHT
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8501 HARCOURT RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-2046
Mailing Address - Country:US
Mailing Address - Phone:317-872-5101
Mailing Address - Fax:317-875-9174
Practice Address - Street 1:8501 HARCOURT RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-2046
Practice Address - Country:US
Practice Address - Phone:317-872-5101
Practice Address - Fax:317-875-9174
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2017-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05010524A2251H1200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035780Medicaid
IN062110022OtherMEDICARE PTAN
IN201035780Medicaid