Provider Demographics
NPI:1871221622
Name:KRAFT, ELISE LOUISE (PT, DPT)
Entity type:Individual
Prefix:
First Name:ELISE
Middle Name:LOUISE
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 1:210B FORT EVANS RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-4497
Mailing Address - Country:US
Mailing Address - Phone:571-367-7960
Mailing Address - Fax:571-367-0157
Practice Address - Street 1:210B FORT EVANS RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-4497
Practice Address - Country:US
Practice Address - Phone:571-367-7960
Practice Address - Fax:571-367-0157
Is Sole Proprietor?:No
Enumeration Date:2022-08-10
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND2525225100000X
VACP014669T225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist