Provider Demographics
NPI:1497285506
Name:BUTZ, ELLEN (DPT)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:BUTZ
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:SIEBEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33900 HARPER AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48035-4258
Mailing Address - Country:US
Mailing Address - Phone:586-350-2644
Mailing Address - Fax:
Practice Address - Street 1:9 N 2ND ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1869
Practice Address - Country:US
Practice Address - Phone:630-526-4200
Practice Address - Fax:630-526-4201
Is Sole Proprietor?:No
Enumeration Date:2017-06-13
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-023015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist