Provider Demographics
NPI:1780850651
Name:HUTTER, MITCHELL (PT)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:HUTTER
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 WEST BELTLINE HIGHWAY
Mailing Address - Street 2:DEAN THERAPY CENTER
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713
Mailing Address - Country:US
Mailing Address - Phone:608-250-1485
Mailing Address - Fax:608-250-1456
Practice Address - Street 1:1806 WEST BELTLINE HIGHWAY
Practice Address - Street 2:DEAN THERAPY CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713
Practice Address - Country:US
Practice Address - Phone:608-250-1485
Practice Address - Fax:608-250-1456
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10957-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI60763OtherDEAN HEALTH INSURANCE