Provider Demographics
NPI:1083275168
Name:HUTTERER, JARED (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:JARED
Middle Name:
Last Name:HUTTERER
Suffix:
Gender:M
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 1:5115 AUTUMN LEAF LN APT 175
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-8647
Mailing Address - Country:US
Mailing Address - Phone:920-629-8891
Mailing Address - Fax:
Practice Address - Street 1:805 ELM ST
Practice Address - Street 2:
Practice Address - City:LAKE MILLS
Practice Address - State:WI
Practice Address - Zip Code:53551-1127
Practice Address - Country:US
Practice Address - Phone:920-648-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14609-24208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation