Provider Demographics
NPI:1821262791
Name:BUETTNER, JOANNE (PTA)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:BUETTNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W61N931 GLENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-1326
Mailing Address - Country:US
Mailing Address - Phone:414-357-5105
Mailing Address - Fax:414-357-0604
Practice Address - Street 1:W61N931 GLENWOOD DR
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-1326
Practice Address - Country:US
Practice Address - Phone:262-377-4174
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI733019225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant