Kristen Lyn Wade, P.T.

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

070015410 Issued in IL

Practice address

535 W Eldorado St
Decatur, IL 62522-2117

Phone

(217) 528-7541

NPI assigned

Feb 6, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Physiotherapy Professionals LLC

  • Physical Therapist
  • Springfield, IL
  • NPI 1801957055
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1360108800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726012800000",
    "number": "1396084653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19248",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627949248",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "535 W ELDORADO ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625222117",
            "telephone_number": "217-528-7541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2921 Greenbriar Dr",
            "address_2": "Suite B",
            "address_purpose": "LOCATION",
            "city": "Springfield",
            "state": "IL",
            "postal_code": "627046421",
            "country_code": "US",
            "telephone_number": "217-546-3301",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "KRISTEN",
        "middle_name": "LYN",
        "name_prefix": "Dr.",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-06",
        "last_updated": "2024-09-11",
        "certification_date": "2024-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "IL",
            "license": "070015410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca A Voyles, MSN, APN, NP-C
• VSR PLLC
• Wabash Memorial Hospital Association
• Rebecca Waddell
• James L Wade III, M.D.
• Kyla Aaliyah Ali Wade
• Carolyn Wagner, NP
• Wal-Mart Stores, Inc (Vision Center 30-1690)
• Wal-Mart Stores, Inc (Vision Center 30-2728)
• Walgreen Co (Walgreens #05719)

• Physical Therapist in Decatur, IL
• Providers in Decatur, IL by specialty
• Physical Therapist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.