Provider Demographics
NPI:1134602634
Name:KRAFT, TROY JONATHAN (PT)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:JONATHAN
Last Name:KRAFT
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 HOSPITAL RD STE 201
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4045
Mailing Address - Country:US
Mailing Address - Phone:410-535-1343
Mailing Address - Fax:
Practice Address - Street 1:3140 W WARD RD STE 206
Practice Address - Street 2:
Practice Address - City:DUNKIRK
Practice Address - State:MD
Practice Address - Zip Code:20754-3047
Practice Address - Country:US
Practice Address - Phone:410-535-3440
Practice Address - Fax:301-327-5374
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01809700225100000X
MD28003225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist