Provider Demographics
NPI:1437174562
Name:MAY, KRISTEN L (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:L
Last Name:MAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:1290 N SUMMIT AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4459
Practice Address - Country:US
Practice Address - Phone:262-468-3480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6712225100000X
IL070-017609225100000X
WI6269-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40361200Medicaid
MN050917500Medicaid
MN6401328OtherMEDICA
MNHP31549OtherHEALTHPARTNERS
MN193K4MAOtherBLUECROSS BLUESHIELD
WI40361200Medicaid
MNHP31549OtherHEALTHPARTNERS
IL202845078Medicare PIN