Provider Demographics
NPI:1396012035
Name:GUTCHE, SAMANTHA H (DPT)
Entity Type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:H
Last Name:GUTCHE
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 MOCKINGBIRD WAY
Mailing Address - Street 2:
Mailing Address - City:OSHKOSH
Mailing Address - State:WI
Mailing Address - Zip Code:54904-7339
Mailing Address - Country:US
Mailing Address - Phone:920-379-6195
Mailing Address - Fax:
Practice Address - Street 1:3332 MOCKINGBIRD WAY
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54904-7339
Practice Address - Country:US
Practice Address - Phone:920-379-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11813-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist