Provider Demographics
NPI:1831595172
Name:KRAFT, KAITLIN (DPT)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:KRAFT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4401 BELLE OAKS DR
Mailing Address - Street 2:SUITE 280
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29405-8537
Mailing Address - Country:US
Mailing Address - Phone:314-348-1588
Mailing Address - Fax:
Practice Address - Street 1:4401 BELLE OAKS DR
Practice Address - Street 2:SUITE 280
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29405-8537
Practice Address - Country:US
Practice Address - Phone:314-348-1588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCPT75872251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic