Provider Demographics
NPI:1891273066
Name:MAIN, KATELYNN ANN (PT, DPT)
Entity Type:Individual
Prefix:
First Name:KATELYNN
Middle Name:ANN
Last Name:MAIN
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 1:2033 SOUTHCROSS DR W APT 407
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7935
Mailing Address - Country:US
Mailing Address - Phone:320-760-7647
Mailing Address - Fax:
Practice Address - Street 1:1500 MADISON AVE STE 5A
Practice Address - Street 2:
Practice Address - City:NEW RICHMOND
Practice Address - State:WI
Practice Address - Zip Code:54017-6693
Practice Address - Country:US
Practice Address - Phone:715-941-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11104225100000X, 2251X0800X
WI16222225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic