Provider Demographics
NPI:1700604782
Name:KRAFT, MCKAYLA ANN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MCKAYLA
Middle Name:ANN
Last Name:KRAFT
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 ANNE ST NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-5109
Mailing Address - Country:US
Mailing Address - Phone:218-751-0220
Mailing Address - Fax:
Practice Address - Street 1:1000 ANNE ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5109
Practice Address - Country:US
Practice Address - Phone:218-751-0220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12982225100000X
ND2787225100000X
NCP21977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist