Provider Demographics
NPI:1619946621
Name:BUTTENBERG, HEIDI JOY (PT)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:JOY
Last Name:BUTTENBERG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14180 SADDLEBOW DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511
Mailing Address - Country:US
Mailing Address - Phone:775-851-7799
Mailing Address - Fax:
Practice Address - Street 1:11331 SOUTH VIRGINIA
Practice Address - Street 2:SUITE 3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511
Practice Address - Country:US
Practice Address - Phone:775-853-9966
Practice Address - Fax:775-853-9969
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1224225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE296531Medicare ID - Type Unspecified