Provider Demographics
NPI:1245283456
Name:MAY, JENNIFER A (PT, MTC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:A
Last Name:MAY
Suffix:
Gender:F
Credentials:PT, MTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13618 E BETHANY PL
Mailing Address - Street 2:#304
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3659
Mailing Address - Country:US
Mailing Address - Phone:720-535-9086
Mailing Address - Fax:720-535-9086
Practice Address - Street 1:13618 E BETHANY PL
Practice Address - Street 2:#304
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3659
Practice Address - Country:US
Practice Address - Phone:720-535-9086
Practice Address - Fax:720-535-9086
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI904-024225100000X
CO254225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40014600Medicaid