Provider Demographics
NPI:1639954787
Name:TUTTLE, BROOKE NICOLE KOPACZ (DPT)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NICOLE KOPACZ
Last Name:TUTTLE
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 1:535 HUNTER HILL RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-1866
Mailing Address - Country:US
Mailing Address - Phone:715-977-1844
Mailing Address - Fax:
Practice Address - Street 1:1100 BERGSLIEN ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-2600
Practice Address - Country:US
Practice Address - Phone:715-684-1505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16439-242251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic