Provider Demographics
NPI:1487036117
Name:KREUTTER, SAMANTHA D (PT)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:KREUTTER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:BIELEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:225000 HUMMINGBIRD RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-2950
Mailing Address - Country:US
Mailing Address - Phone:715-359-6442
Mailing Address - Fax:715-393-0390
Practice Address - Street 1:225000 HUMMINGBIRD RD STE 100
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-2950
Practice Address - Country:US
Practice Address - Phone:715-359-6442
Practice Address - Fax:715-393-0390
Is Sole Proprietor?:No
Enumeration Date:2015-06-18
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13007-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist