Provider Demographics
NPI:1437387867
Name:KREY, AMANDA CLAIRE (DPT)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CLAIRE
Last Name:KREY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:CLAIRE
Other - Last Name:WELLS
Other - Suffix:
Other - Last Name Type:Former Name
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 1:3716 RIDGE MILL DR
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9231
Practice Address - Country:US
Practice Address - Phone:614-771-8537
Practice Address - Fax:614-771-8538
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA44112251S0007X
WI11629-24225100000X
OHPT014384225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH189800Medicare PIN
WI830420047Medicare PIN
WIK400165389Medicare PIN
WI832070029Medicare PIN