Provider Demographics
NPI:1134314552
Name:HELLENBRAND, KRISTINA (MPT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:HELLENBRAND
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2639 NEW PINERY ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901
Mailing Address - Country:US
Mailing Address - Phone:608-742-9356
Mailing Address - Fax:608-742-9358
Practice Address - Street 1:2639 NEW PINERY ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901
Practice Address - Country:US
Practice Address - Phone:608-742-9356
Practice Address - Fax:608-742-9358
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10010024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40423100Medicaid
WI000082625Medicare UPIN